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U.S. to make More Drugs Easily Available, Cutting Role Doctors Play
- anoncoward111 8y agoYikes, my girlfriend is applying to med school as we speak. The medical industry is certainly a highly regulated, potentially overpriced service for decades now. When I see a headline like this, I have to seriously ask myself: "Is this when the bubble finally pops, or will it be status quo for another generation?"
- davismwfl 8y agoThe medical changes in the US take forever for change to occur. Even if greater access to some of these common medications is to happen, it will take close to a decade or more to see it meaningfully impact the industry. There will likely be a few drugs that become available before that, but likely not many and not enough to change the cost basis much. The US medical and pharmaceutical community is a very powerful political lobbying group as a whole and while some of this might be good for them they are not great at change, so it will be fought for years to come. Medicine in the US may become more affordable, but will not lose its prestige or the solid return on investment for physicians overall, IMO.
- jrochkind1 8y agoI'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 disintermediated consumers, and those marketing dollars to have a great return on investment. Do you have any reason to think otherwise? Hmm, pharmaceutical industry lobbying seems to have had a significant bump in 2017, from $250 million to $280 million based on lobbying paperwork filed... https://www.opensecrets.org/lobby/indusclient.php?id=H04&year=2017 https://www.opensecrets.org/lobby/indusclient.php?id=H04&yea...
- ars 8y agoIt's not as great as you think for the pharmaceutical industry. They can't charge as much for OTC drugs because people won't pay for it. If the drug (or a similar in class competitor) is available OTC then they also can't charge as much via prescription. So both ways, prices go down.
- davismwfl 8y agoMany 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, < $10 gets you a 100 cnt of 200mg pills at most pharmacies OTC in the US. But a physician can and will still prescribe 800mg Ibuprofen tablets to a patient. That prescription for say 40 tablets may cost the consumer $5-10 co-pay, but insurance has paid $35 or more. So the price per pill is drastically different, you can take 4 of the OTC pills and get the same affect. 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.
- ars 8y ago> 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-rebates/index.html 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 probably the #1 thing that could help US medical spending. And as much as people hate Trump, he's probably the only one with the actual ability, and desire to do something about it. Other presidents have cared, but they were too risk adverse, Trump would be like "hmm, looks good - do it and let's see what happens". That kind of risk taking gets him in a lot of trouble, but it's why he was elected, and why he still has support despite the INCREDIBLY stupid things he says.
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- basic1 8y agoIt's just shifting to pharmacists who are also medical professionals, it was inevitable given the success of pharmacy based immunization programs.
- gbacon 8y agoI don’t think you understand the way the outrage on the internet game is supposed to work.
- dv_dt 8y agoHighly regulated except for one critical aspect, and that is price. Other nations control the prices that are allowed to be paid for drugs.
- woolvalley 8y agoDoes your GF really want to rubber stamp things epipen Rxs? Once you have the allergy diagnosis, it generally doesn't go away. It's kind of like low tech automation.
- anoncoward111 8y agoI think these days, whether or not a doctor or physician assistant "wants" to do something isn't really considered in the equation. Basically, the schools jack up the medical practitioners with hundreds of thousands in debt, and the practitioners will do absolutely whatever is required to pay it off and eek out a living :(
- medntech 8y agoI wouldn't do absolutely whatever is required to pay off my debt nor would my peers. But we can relate to the concerns of hundreds of thousands in debt as far as we can't "want" anything. We're just as trapped in the system as the patients we treat. No wonder why there is a spike in suicides after medical school.
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- jl2718 8y agoIt’s literally not sustainable. The size of the population that has been priced out of access to medical services is approaching a majority if not already. 90% of Americans avoid doctors like the plague. 10% blow out their insurance like they just won the lottery.
- ryandrake 8y agoI’m one of those 90%. I simply don’t trust that doctors’ incentives align with mine. Too often it seems they do nothing but shrug and bill you for the visit, send you for expensive blood tests, or send you to their specialist med school buddies so they can bill you for 5 minutes too. Then there’s the billing: you don’t know what you’re going to pay until months later, after you sign a form saying you’ll pay anything they want! They will never quote upfront and will never itemize what they did.
- 15155 8y agoMy favorite doctors in 2018 all take cash and are all substantially more up-to-date than most insurance-system GPs. The A-players have left the insurance system or are in academia, make no mistake. For some cost-prohibitive things such as surgery, you really don't have much choice, though.
- geomark 8y agoFor some cost-prohibitive things such as surgery, you really don't have much choice, though. Go overseas. To one of the medical tourism destinations. The care is far superior and the cost a fraction. Cheaper than the insurance premiums alone.
- refurb 8y agoSimilar to this idea, the province of Alberta in Canada allows pharmacists to write prescriptions for patients with only the only limit that they can't prescribe controlled substances.
- walshemj 8y agoPresumably only for trivial conditions id hope. Edit it will also lead to over prescribing of antibiotics and cause drug resistance to rise
- cestith 8y agoI'd actually hope not. Many people have chronic conditions which require periodic visits to a doctor mainly for the same prescription to be renewed. A doctor should absolutely be involved in follow-up management, but don't make patients go every two or three months just to get the same prescription as last time and to get insurance to cover the meds. Once a chronic but potentially well-managed condition is diagnosed, let people record their blood pressure, blood sugar, weight, and whatever and submit it for records. Let them renew their prescription with the pharmacy without spending hours finding an appointment that then takes hours to actually be seen. If their condition hasn't changed, once or twice a year with the doctor should be plenty.
- walshemj 8y agoAs some one who has lived with a serious chronic condition id say the opposite - I don't have anyting against my local pharmacy (and they have been good and even hand delivered meds ) But I suspect that they probably have two at most patients like me as opposed to the nephrology specialists who see dozens of people like me each week.
- cestith 8y agoAre there easy at-home tests that would be useful data for your doctor? Is once a month necessary for this specific condition? Is three months? What about keeping records and sending them to the doctor every couple of weeks so an extra appointment can be scheduled, but only once every four or six months normally? I have hypertension. I've had it for years. It doesn't just go away, but it doesn't (at least in my history) rapidly get worse. I can take my blood pressure at home and chart it. The same medication I have always taken works and at the same dosage. Yet most doctors want to see me every two months to renew the prescription, prescribing a one-month supply with one refill. The stuff's shelf stable for a few years. Why can't I get a six month prescription?
- jrochkind1 8y agoThis will be great for pharmaceutical profits, not so great for insurance premiums.
- tonyedgecombe 8y agoProbably not very good for patients either.
- openasocket 8y agoI think if anything this would slightly lower insurance premiums, since insurance generally doesn't cover nonprescription medications. As for the effect on pharmaceutical companies, it could go either way. On one hand, it makes it much easier for customers to buy them. On the other, the customer is paying for it out of pocket, and the price is right there on the box. If there are multiple drugs that treat the same condition, customers will take into account price when choosing which one to buy, and so you'll start to see the effects of a free market encouraging competition and driving down prices. Of course, if there isn't any competition for that drug category they can make the price whatever they want and the poor will wind up screwed.
- ars 8y agoYou have that 100% backwards. Insurance premiums will go down since OTC drugs are not covered by insurance. Pharmaceutical profits will also go down because people are much more price sensitive for OTC drugs, so they can't charge as much.
- darpa_escapee 8y agoI could be wrong, but I was under the impression that some plans will cover OTC medication if a doctor "prescribes" them for you. According to the article, these drugs won't be considered OTC, they still need a pharmacists approval. I don't know how that will affect coverage, if at all.
- ars 8y ago> I could be wrong, but I was under the impression that some plans will cover OTC medication if a doctor "prescribes" them for you. Yes, that is correct. But the idea here is to have a person decide to take it without having a Dr prescribe it, so insurance will not cover it.
- pkaye 8y agoI think this is good. For many people a lot of the costs are the doctor visits. Look at the Walmart 100 common generics for $4. I wouldn't be surprised if 50% of the hospital visits can be solved by one of these generics but then we add an expensive doctor visit to get a $4 medicine. There needs to be a more affordable solution.
- dragonwriter 8y ago> I wouldn't be surprised if 50% of the hospital visits can be solved by one of these generics but then we add an expensive doctor visit to get a $4 medicine. Its really not surprising that the expensive part isn't the drug but the expertise to select the correct drug; it's true in lots of fields that the equipment or consumables aren't nearly as expensive as the brain to choose which of those to use and how. Bits are a lot less expensive than the software engineers that arrange them.
- seanmcdirmid 8y agoNurse practitioners are already great for when you just have an infection and need some anti-biotics. They have little clinics with them in many drugstores these days.
- athenot 8y agoNPs can already prescribe drugs (just not narcotics, iirc).
- neurotech1 8y agoNurse Practitioners can prescribe Class II narcotics in most states, if their supervisor physician allows it.
- athenot 8y agoThanks for clarifying that.
- athenot 8y agoI have mixed feelings about this, especially considering the US is the only first world country where direct-to-consumer marketing is allowed for medications. Bypassing the prescription requirement is of course of significant value to drug companies, who expend quite a bit of resources to sway doctors with free lunches, conferences and soft persuasion tactics. Usually I welcome the freedom to chose but this doesn't increase availability: the bottleneck is not with the doctors, it's with pricing. Drug prices aren't going to go down with this measure, and will remain 3-5x the price of the exact same meds sold in Europe.
- nnm 8y agoOne of my friends has type I diabetes, in more than one times, she needed urgent visit/call to her doctors just to get the medicine she has being taken for years.
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- veridies 8y agoI have type 1 diabetes, and this is a constant fear of mine. It’s absurd that I should have to go through my insurance company to be able to get more medicine if I need to.
- srameshc 8y agoThis is the most atrocious thing to do by not to letting people with Type 1 buy their Insulin medication. I just don't see a reason why this is so much regulated. Like some meds which are partially regulated, where you can request a Pharmacist and they can give you would be reasonable in this case.
- 15155 8y ago
- nnm 8y agoFinally we come to common sense.
- rsynnott 8y ago> Patients could answer questions on a mobile-phone app to help determine whether they should be able to access a medication without a prescription. Day 2: Websites showing the correct answers to get anything you want show up. This is an absolutely bonkers idea.
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- xamuel 8y agoAs opposed to the alternative where people buy said meds from a dude in an alleyway?
- matt4077 8y agoBy that logic, I should already be able to buy medication from back-alley dudes. While I could quite easily get ahold of Marijuana and other illegal drugs on the street or the dark side of the net, I have never seen an offer for non-narcotic prescription drugs.
- someguydave 8y agoNo, the real "bad scenario" is "people go without drug that could help them because doctors & insurance are seen as too troublesome and expensive"
- jorblumesea 8y agoThe true root of the problem is largely systemic: healthcare is a for-profit system in this country and was poorly designed in the first place. For example, employment based health insurance is largely a relic from WW2 because companies couldn't increase wages and offered it to entice workers. This was logical at the time, but in the 21st century makes very little sense. Until we can turn it into a true public service, little will change. We can band aid the solution as much as we want but we will never be able to resolve the true core problems.
- chobytes 8y agoExciting news. My only hope is they they would simultaneously dial back medication advertisements.
- aaavl2821 8y agolooks like this is a draft guidance document, so it may not actually come into effect for a while. something like this seems like it would be massively controversial, and thered probably be a lot of debate on both sides. overall though the idea is very interesting. something like 20% of US health spend is on outpatient care. i dont know how much of that relates to medication management, but id imagine a lot does. PCPs get paid more when they manage a patients medication, and many psychiatrists make nearly all their income from adjusting prescriptions. im sure other specialties are similar. so this theoretically enables some of that work to be done without the physician. this could significantly reduce cost of outpt services, although it will depend very much on how hard it is for pharma companies to demonstrate non rx use of their products is safe and effective. it may be the case that only a few meds actually are eligible, or that many are, once the guidance is finalized i havent read the guidance doc yet so dont really know how this would play out in terms of who decides what to rx if not a doc. i personally am sort of disappointed to see doctors becoming even more sidelined. doctors really do an important job of filtering info for patients, advocating / negotiating with insurance companies, and looking out for them. this could potentially be one less protection for patients as large companies get more power to control info. id like to see cost taken out of the system by reducing pricing power by breaking up large providers rather than disintermediating doctors, but that isnt within fda's mandate, so i understand why fda would go for something like this this could be good for patients if it is implemented in a way that doesnt give pharma too much power over patients. cost would decrease and access to meds could increase. however there may be more patients taking medicines for reasons other than the health benefits (ie marketing power / influence)
- mullingitover 8y ago> i personally am sort of disappointed to see doctors becoming even more sidelined. doctors really do an important job of filtering info for patients, advocating / negotiating with insurance companies, and looking out for them Tell that to my doctor, who on a routine checkup sent me to the lab for lab work without clearing it with my insurance company. I got a nice $600 bill for the lab work that the insurance company didn't agree was 'preventative.' After calling the insurance company they ended up waiving it, but told me that in the future I should clear every single thing the doctor orders with them, because the doctors won't do it. The supply of doctors in the US is artificially constrained, and physician care costs more here than anywhere else in the world. Anything that removes them from the equation, especially for basic things like prescriptions, is a plus in my book.
- Spooky23 8y agoSounds like a way to mimic the success of over the counter medications like ibuprofen, whose prices have been slowly creeping up for years. Many of the major profitable blood pressure and statins are off patent, so the drug companies need to make more money. I’m sure this status will limit or eliminate insurance contributions, so now you’ll pay more for generic because 50 million individuals lack the buying power of CVS and the other PBMs.
- mobilefriendly 8y agoIncorrect. 200 mg Ibuprofen is 2 cents a pill at Walmart. https://www.walmart.com/search/?query=ibuprofen%20200mg%20500%20count&cat_id=0&typeahead=ibu https://www.walmart.com/search/?query=ibuprofen%20200mg%2050...
- vageli 8y agoPointing at a single data point is not enough evidence to show that an upwards trend does not exist.
- pessimizer 8y agoThe single data point is the exact same single data point mentioned in the comment as the only evidence that an upwards trend existed in the first place.
- Spooky23 8y ago...And the generic gelcap that is heavily marketed and merchandises better costs 7x more.
- edtruji 8y agoWalmart physical stores “brick and mortar”, charges different price for the same product, taking into account different “factors” like local competition.
- paulie_a 8y agoLet me know when I can get Adderall without having to jump through endless hoops...I can probably get cocaine delivered to my door with less effort.
- jl2718 8y agoBravo. 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.
- stochastic_monk 8y agoYou 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.
- jklinger410 8y agoGreat, you've discovered the problems they solve for. Now solve the problems they create. Then, weigh the two against one another. Let us know what you conclude. Then we start the lobbying process...
- vibrio 8y ago...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.
- stochastic_monk 8y agoThat’s a good, simple example demonstrating a problem. I also think pharmacokinetic effects are likely underappreciated by the general public.
- mullingitover 8y agoIsn'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.
- rdiddly 8y agoWhen 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 them recommend and prescribe [drug]. It makes you feel sorry for the doctor almost.
- madamelic 8y ago>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, you could be your own lawyer, doctor and engineer but there are very good reasons they exist: to make sure you aren't doing dumb things they know better.
- shub 8y agoOne 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.
- barftransit 8y agoYes, and when you're left alive and disabled you should have the right to become a ward of the state.
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- cm2012 8y agoThis can't come soon enough. I hate going to the doctor in general, but especially for basic shit I've been using for years.
- Communitivity 8y agoThere 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 need X' we'll get 'You need X if you have any of a, b, and c...get it now before it's too late'. Also, the doctor is aware of your health history and can spot reasons you specifically shouldn't take a drug, or better alternatives. Maybe you are overweight and one diabetes drug would work for you, but this other one will also help you lose weight. Maybe you have a loss of kidney function, and shouldn't be taking metformin. Your pharmacist should catch drug interactions, but they can't catch problems that would result from your past medical history. For me this is big pharma getting their way, at our cost, in more ways than one.
- gaius 8y agoAlso, 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.
- tptacek 8y agoThat 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.
- WillPostForFood 8y agoOn your first visit or every visit thereafter? I think the issue is the overhead of unecessary repeat visits.
- cimmanom 8y agoHow do they propose to deal with the potential dangers of drug interactions?
- LinuxBender 8y agoToday 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.
- cimmanom 8y agoYou're fortunate to have both the intelligence and the time to do that effectively. Not everyone has the capability to assemble, decipher, and fully understand that information.
- LinuxBender 8y agoIn my opinion, everyone should take the time to study the drugs that they are prescribed, as well as the interactions to foods and supplements. I believe this is more important that anything related to one's career or investments. You only get one body.
- cimmanom 8y agoIt sounds to me as if you're failing to grasp just how difficult that is to do for at least 80% of the population.
- LinuxBender 8y agoI completely understand that a majority have a big learning curve ahead of them. I am just not a fan of corporations and laws targeting the lowest common denominator. I should have the ability to consent to making these decisions myself, assuming I am willing to take the risks. I would even be fine with getting a government issued certification that verifies I am educated enough to make an informed decision.
- lev99 8y ago> Patients could answer questions on a mobile-phone app to help determine whether they should be able to access a medication without a prescription. The primary issue I am concerned with is self ownership of my body, and the freedom to choose for myself which drugs I will consume. Transferring the permission process from a human medical professional to an algorithmic goverment agent does not give me anymore of what I want.
- danso 8y agoA permission process seems inextricable from a system in which there are regulations. But algorithmic agent would theoretically make approved drugs more accessible. The expense and time of a doctor visit is enough friction to stop people from getting drugs they may find beneficial.
- wu-ikkyu 8y agoThere are many systems in which production requires the following of regulations but the purchasing and consumption does not, i.e. food.
- danso 8y agoThere is definitely more leeway with food. But the FDA, for instance, bans raw milk from interstate sales: https://www.npr.org/sections/thesalt/2015/02/20/387558373/why-some-states-want-to-legalize-raw-milk-sales https://www.npr.org/sections/thesalt/2015/02/20/387558373/wh... Local governments can also regulate what food is purchaseable, more specifically, who is legally allowed to sell food; restaurants have to agree to pass health inspections, for instance. As another example: Peking Duck was effectively illegal because of health regulations until legislators (of Asian descent) were able to pass laws saying otherwise: https://www.nytimes.com/1982/03/31/us/around-the-nation-california-panel-backs-a-chinese-duck-bill.html https://www.nytimes.com/1982/03/31/us/around-the-nation-cali...
- lev99 8y agoRecreational Cannabis has lots of regulations, and the only permission needed is a legal id and being an adult in several states. My goal isn't to reduce friction for accessing medicine. A person would be a fool to not jump through the hoops required to gain access to life improving medications. The low cost of a quarterly doctor's visit for a continuous prescription is well worth the benefits a modern pharmaceutical can provide. My goal is to have ownership of my body. It's a personal insult that I even have to ask permission.
- exabrial 8y agoMy 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.
- flukus 8y agoYes, it's incredibly inefficient to have highly trained, expensive doctors acting as tier-1 tech support. But they have a powerful union, so they can keep being paid top dollar for their grunt work.
- javadocmd 8y agoThe kinds of doctors that work as "tier-1 tech support" -- that is, primary care -- are not being paid top dollar, believe me. After you account for the cost of education, delay of entry to the workforce, hours worked per week, and the fact that insurance compensation models are biased towards specialty care and procedures, and it starts to look like bad financial planning.
- medntech 8y ago"Some conditions are easily diagnosable and the side effects of the drugs are minimal." Sounds like a good time to see an NP/PA. Things should be triaged more effectively. Pharmacists <-> PA/NP <-> MD/DO.
- hrygolis 8y agoThat chain you're outlining is part of the problem with health care in the US. It's not just pharmacists or PAs, it's psychologists, optometrists, dentists... The problem is we have this over regulated system that doesn't recognize the actual capabilities of many in the system that could be doing a lot more than they are, we're it not for professional lobbying around turf. There are huge unrecognized bottlenecks to care that have everything to do with inaccurate regulatory assumptions about who can do what, starting with the consumer themselves. I get a little upset about the idea of triaging down a chain, because the triage chain itself is a flawed idea. I dream of a much more competitive system where people get drug advice from professionals based on those professionals' training and expertise, regardless of specific training pathway or background.
- Lanthanide 8y agoI 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. Things like insulin, birth control medications, hypertension medications, even antidepressants and anti-psychotics- they are all OTC. And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor. The reason that this is the norm here is twofold; one, health insurance wasn't much of a thing here until a few years ago. The second reason (and the reason health insurance didn't factor in until recently) is that the socialized healthcare system here was (and still is) stretched thin; seeing a doctor to get prescriptions for every little thing becomes prohibitively difficult, with appointments taking months. It's asinine to expect someone suffering from, say, an acute athsma attack to try to navigate ERs or try to see a doctor on short notice during a crisis, when a pharmacist would be able to dispense the exact medication needed, leaving the others free for more complex cases that need closer attention. Edit: this actually created a bit of culture shock for an older friend of mine. He was traveling to an EU country for the first time and didn't do his homework- he thought he he could simply walk into any pharmacy and ask for a pack of his cholesterol medication, as he usually does back home. I don't envy the poor pharmacist that had to keep trying to explain the dispensing system to him and to emphasize that yes, they are aware that it's Lipitor, not morphine, it's just how the regulation is.
- bumholio 8y agoI find it doubtful that Atorvastatin was not available for health/risk reasons. I can buy it cash in 5 minutes, no questions asked. What tends to happen in some EU countries is that the retail drugs are heavily subsidized by the government, and then all kinds of kludges are put in place to prevent people buying bulk quantities and reselling them in some other EU country where the price is much higher - the export itself being 100% legal on the single market.
- phil21 8y agoBeyond time. I find it pathetic that living in the "land of the free, home of the brave" I need to travel out of the country to be able to pick up basic medications without a permission slip from the authorities. I utterly refuse to pay $100+ so I can get a signed hall slip from a doctor to get what I knew I already needed. This perhaps will save me some travel costs every few years when I go to restock the personal pharmacy.
- toomanybeersies 8y agoInteresting that they mention Naloxone. In Australia (VIC at least), Naloxone is available for free over the counter at the pharmacy. Needles are also readily available (and I'm fairly sure they're free). It doesn't really make sense for Naloxone to be prescription. Smack users aren't going to go to the doctor for a prescription. You can't get high off the stuff, all it can do is take you off a high and keep you breathing until an ambulance arrives. On the other hand, if I want painkillers with opioids like panadeine (codeine + acetaminophen), I need to get a prescription. Same if I want cold medicine containing psuedaephidrine, because I might make methamphetamine with it.
- danieltillett 8y agoIf you are in Australia you can get pseudoephedrine without a prescription - you just give the pharmacist your drivers license and ask for the stuff that works. How pharmaceutical companies can be allowed under our fair trading laws to sell phenylephrine I don’t know.
- cassowary37 8y agoI'm always struck by the intensity with which some HN folks hate their doc - reminded of this by the number of comments invoking conspiracy theories about docs scheduling extra appointments to bill more or push more generic drugs. Perhaps obvious but perhaps not: in the US and most EU countries I'm aware of, you can choose a new doc. You can shop around. Despite the flaws in online reviews, just as with Amazon, you can read between the lines. Choosing instead to avoid healthcare completely seems self-defeating. I'm sorry to read so many horror stories - going to the doctor even for docs (especially for docs?) can be a frustrating experience. But while you're burning down the FDA, at least shop around and find yourself a good primary care doc.
- seibelj 8y agoA rural hospital kept my grandma alive 10 extra days to milk Medicare for the maximum allotment. There is nothing American healthcare won’t do to make a buck
- rjurney 8y agoBut your parents have control over hospice arrangements. The only thing a hospital can legally in most states do once you decide to let her die is to sedate if necessary and cut off food and let the body shut down. What gives you the idea it was a conspiracy?
- jessaustin 8y agoWow, if you knew anything about how shitty our system is to dying people and their families I suspect you wouldn't be sealioning someone in GP's position.
- PatentlyDC123 8y agoFor me the issue is not exactly “burning down” the FDA, but rather changing its purpose from regulatory to only advisory (and hopefully changing associated statutes). The FDA provides a very valuable service by identifying the risks associated with various food and drug. It is one thing to educate the public and say “XYZ presents risk of ABC for this specific group of consumers.” It is a very different thing to also add “therefore, consumers cannot make the decision to take on the risks associated with XYZ because the FDA (and associated governing bodies) have decided the general population should not take these risks (regardless of the overall risk level and their individual risk factors).”
- rjurney 8y agoThis sounds like a bad idea until I remember that most countries have this arrangement and I've made liberal use of it to great benefit... but mostly that has to do with the lower cost of drugs everywhere but the United States. I stock up every time I go to Europe, and I just made a run to Tijuana for medication my insurance company doesn't cover. The downside is that insurance wouldn't cover these often expensive medications if they are OTC.
- veryconfident 8y agoThis is a good thing. Doctors, while good for some tasks, can have an adverse effect on the flow of medical issue processing and patient care commodity distribution. This initiative will lift the barriers to competition that forces us to depend on the stodgy old-fashioned personal visits. Medical issue processing should require no more than a few snapchats per conflict.
- Gatsky 8y agoGiven the degree to which people waste time and money taking supplements that do absolutely nothing, this doesn’t seem like a great idea. Sure, if you are on HN and stay up late reading meta-analyses it would be fine, but then governing the “Democratic Republic of HN” would be very easy in many ways. If there was actually a proper system to enable evidence based and cost-effective usage of pharmaceuticals without doctors it might improve things for patients, but I don’t see that there is.
- dotcoma 8y agoGreat for business, bad for people. Welcome to the US of A.
- baybal2 8y agoIn China, you can't even buy loperamide. I think, they think that you can get high on it if you eat a bucket load of it