6 ms·

I think you would be amazed how many people don't "have a doctor" and simultaneously are the same people who would benefit from this.

giantg2 3y ago
I'm pretty sure you don't have to "have" a doctor for this. MinuteClinics and such can provide this. I would guess there are websites you can get Rx through too.
- 0cf8612b2e1e 3y ago
  That’s still a needless barrier. If you are poor every dollar counts and being required to pay for a medical professional to rubber stamp a prescription does more harm than good.
  - giantg2 3y ago
    I'd like see the data that supports that. If true, we would do away with the prescription process altogether for most drugs.
    - 0cf8612b2e1e 3y ago
      That women find getting birth control a hassle? Ask anyone.
      - giantg2 3y ago
        No, that the prescription process is providing more harm than good.
        travisjungroth 3y ago
        Having a doctor rubber stamp a prescription does more harm than good. If the argument is that getting a prescription is such a simple task it should cost almost nothing and be done instantly, then it likely doesn’t need to exist as a barrier at all.
        giantg2 3y ago
        "Having a doctor rubber stamp a prescription does more harm than good." The question was how/why, not to simply restate it as fact wilit supporting data. "If the argument is that getting a prescription is such a simple task it should cost almost nothing and be done instantly, then it likely doesn’t need to exist as a barrier at all." That's not the argument. The argument is that the current system already meets the needs, so what real benefit does OTC provide? It's mostly a counterpoint to someone claiming that it's an overly complicated process. Even if it is cheap and fast, the benefit to an Rx is that someone reads the 6 or so questions off the Epic screen (or the user answers them on online) to ensure there are no interactions or elevated risks. I'm not saying OTC is the wrong answer, but I'm not seeing any real arguments for real added net benefit from it.
        0cf8612b2e1e 3y ago
        Net benefit is the enormous hassle a woman has to go through to get an approved treatment. Annual checkup, prescriptions only good for three months, and then typically only allowed to pickup one month dose at a time. That is a huge logistical burden being put on people. Maybe if a prescription was annual and included a year of pills, that would make the OTC case marginally less compelling. Given the status quo, OTC would be an improved quality of life for many.
        giantg2 3y ago
        Those are not restrictions under the Rx process. One can easily access hormonal Rx birthconrtol online - virtual appointment and mailorder pharmacy with auto renew. If people are unhappy with their service, there are other providers able to provide a convenient experience. You can't get a year of pills at one time. These pills expire 1 year from the manufacture date.
        travisjungroth 3y ago
        You're talking about a theoretical "one" that can easily get birth control. In practice, this does act as a significant barrier for a large portion of the population. It's easy to forget this in an Amazon/Doordash/Instacart world, but online ordering doesn't work for everyone. For example, 4.5% of US households are unbanked.
    - TheCoelacanth 3y ago
      I can walk into a drug store and choose from aisle after aisle of prescription-free drugs, so I think we have already done that.
      - giantg2 3y ago
        This is false equivancy. We would need to view that on an individual basis. Just because we have done it for one type of drug, doesn't mean the concerns are the same for another type. This is especially true when considering alternatives during evaluation.
        TheCoelacanth 3y ago
        What evidence do you have that they didn't properly consider this for this one specific drug when we trust them to do it for hundreds of other?
        giantg2 3y ago
        In my opinion, they are not taking a systems thinking view when considering the alternatives. They mention risks associated with cancer recurrence, but then say it is unknown how high the risk is. There doesn't seem to be any mention of the probable increase in risk of developing certain cancers, like gliomas. They mention that STD rates will go up if condom usage decreases, yet didn't measure if there was an increase or decrease in condom usage associated with the product. They also seem to ignore that making the pill OTC may influence some people to rule out higher efficacy prescription options like IUDs. They talk about almost half of pregnancies being unplanned, yet there was no real analysis on how many of those would be prevented by this OTC pill. It feels to me like there wasn't much investigation or thought involved in the overall process. They're just going to use the safety study from 1973 and a small nonprescription study to bring back a pill that was uneconomical for the company to sell as Rx. Seems a lot like the notorious 510k process they use for medical devices. So I'm not saying it's the wrong thing to do, but I'm skeptical of the benefits. They don't have any compelling reasoning to make me believe there will be a bet benefit when they fail to quantify several of the risks and only provide a comparative analysis with OTC only products of the potential failure rates without any impact analysis on the desired metric of unintended pregnancies.
    - Zak 3y ago
      > If true, we would do away with the prescription process altogether for most drugs. That might not be a bad idea. In theory, a prescription means that a doctor who has an intimate knowledge of the patient's health works with the patient to make a carefully-considered mutual decision about medication. In practice, much of the time the process is just a formality which imposes a huge time and financial cost on some patients as well as reducing the time the doctor has for patients who really need more attention. In the past, when access to information was more difficult, this might have been necessary. In the modern world, a simple automated flowchart on a pharmacy website or in-store terminal can do as good a job selecting appropriate medications, avoiding drug interactions, screening for side effects, and informing patients how to take the drug correctly than a doctor. Of course, not every condition can be treated by merely dispensing pills, nor is this appropriate for medications that require more in-depth monitoring or have severe public health consequences. Advertising drugs should probably be more restricted than it is now to put such a system in place.
      - giantg2 3y ago
        I agree. Most of the "flow charts" systems already exist and are used today by the doctors and pharmacists. The only real barrier to opening these up to the public is they would need to be translated to layman terms and provided detailed definitions. WebMD and Drugs.com do this, but perhaps not well. We would also need some sort of guidance or check by the pharmacy just a to rule out the classic "WebMD says I'm dying" panick, or to order/interpret diagnostic tests.

giantg2 3y ago

I'm pretty sure you don't have to "have" a doctor for this. MinuteClinics and such can provide this. I would guess there are websites you can get Rx through too.

0cf8612b2e1e 3y ago
That’s still a needless barrier. If you are poor every dollar counts and being required to pay for a medical professional to rubber stamp a prescription does more harm than good.
- giantg2 3y ago
  I'd like see the data that supports that. If true, we would do away with the prescription process altogether for most drugs.
  - 0cf8612b2e1e 3y ago
    That women find getting birth control a hassle? Ask anyone.
    - giantg2 3y ago
      No, that the prescription process is providing more harm than good.
      - travisjungroth 3y ago
        Having a doctor rubber stamp a prescription does more harm than good. If the argument is that getting a prescription is such a simple task it should cost almost nothing and be done instantly, then it likely doesn’t need to exist as a barrier at all.
        giantg2 3y ago
        "Having a doctor rubber stamp a prescription does more harm than good." The question was how/why, not to simply restate it as fact wilit supporting data. "If the argument is that getting a prescription is such a simple task it should cost almost nothing and be done instantly, then it likely doesn’t need to exist as a barrier at all." That's not the argument. The argument is that the current system already meets the needs, so what real benefit does OTC provide? It's mostly a counterpoint to someone claiming that it's an overly complicated process. Even if it is cheap and fast, the benefit to an Rx is that someone reads the 6 or so questions off the Epic screen (or the user answers them on online) to ensure there are no interactions or elevated risks. I'm not saying OTC is the wrong answer, but I'm not seeing any real arguments for real added net benefit from it.
        0cf8612b2e1e 3y ago
        Net benefit is the enormous hassle a woman has to go through to get an approved treatment. Annual checkup, prescriptions only good for three months, and then typically only allowed to pickup one month dose at a time. That is a huge logistical burden being put on people. Maybe if a prescription was annual and included a year of pills, that would make the OTC case marginally less compelling. Given the status quo, OTC would be an improved quality of life for many.
        giantg2 3y ago
        Those are not restrictions under the Rx process. One can easily access hormonal Rx birthconrtol online - virtual appointment and mailorder pharmacy with auto renew. If people are unhappy with their service, there are other providers able to provide a convenient experience. You can't get a year of pills at one time. These pills expire 1 year from the manufacture date.
        travisjungroth 3y ago
        You're talking about a theoretical "one" that can easily get birth control. In practice, this does act as a significant barrier for a large portion of the population. It's easy to forget this in an Amazon/Doordash/Instacart world, but online ordering doesn't work for everyone. For example, 4.5% of US households are unbanked.
  - TheCoelacanth 3y ago
    I can walk into a drug store and choose from aisle after aisle of prescription-free drugs, so I think we have already done that.
    - giantg2 3y ago
      This is false equivancy. We would need to view that on an individual basis. Just because we have done it for one type of drug, doesn't mean the concerns are the same for another type. This is especially true when considering alternatives during evaluation.
      - TheCoelacanth 3y ago
        What evidence do you have that they didn't properly consider this for this one specific drug when we trust them to do it for hundreds of other?
        giantg2 3y ago
        In my opinion, they are not taking a systems thinking view when considering the alternatives. They mention risks associated with cancer recurrence, but then say it is unknown how high the risk is. There doesn't seem to be any mention of the probable increase in risk of developing certain cancers, like gliomas. They mention that STD rates will go up if condom usage decreases, yet didn't measure if there was an increase or decrease in condom usage associated with the product. They also seem to ignore that making the pill OTC may influence some people to rule out higher efficacy prescription options like IUDs. They talk about almost half of pregnancies being unplanned, yet there was no real analysis on how many of those would be prevented by this OTC pill. It feels to me like there wasn't much investigation or thought involved in the overall process. They're just going to use the safety study from 1973 and a small nonprescription study to bring back a pill that was uneconomical for the company to sell as Rx. Seems a lot like the notorious 510k process they use for medical devices. So I'm not saying it's the wrong thing to do, but I'm skeptical of the benefits. They don't have any compelling reasoning to make me believe there will be a bet benefit when they fail to quantify several of the risks and only provide a comparative analysis with OTC only products of the potential failure rates without any impact analysis on the desired metric of unintended pregnancies.
  - Zak 3y ago
    > If true, we would do away with the prescription process altogether for most drugs. That might not be a bad idea. In theory, a prescription means that a doctor who has an intimate knowledge of the patient's health works with the patient to make a carefully-considered mutual decision about medication. In practice, much of the time the process is just a formality which imposes a huge time and financial cost on some patients as well as reducing the time the doctor has for patients who really need more attention. In the past, when access to information was more difficult, this might have been necessary. In the modern world, a simple automated flowchart on a pharmacy website or in-store terminal can do as good a job selecting appropriate medications, avoiding drug interactions, screening for side effects, and informing patients how to take the drug correctly than a doctor. Of course, not every condition can be treated by merely dispensing pills, nor is this appropriate for medications that require more in-depth monitoring or have severe public health consequences. Advertising drugs should probably be more restricted than it is now to put such a system in place.
    - giantg2 3y ago
      I agree. Most of the "flow charts" systems already exist and are used today by the doctors and pharmacists. The only real barrier to opening these up to the public is they would need to be translated to layman terms and provided detailed definitions. WebMD and Drugs.com do this, but perhaps not well. We would also need some sort of guidance or check by the pharmacy just a to rule out the classic "WebMD says I'm dying" panick, or to order/interpret diagnostic tests.