Wednesday, September 26, 2007

Sumtin' jes' ain't right

I read an interesting article in today’s paper about how the US is weighing whether to make some drugs more easily available by letting pharmacists dispense them from behind their counters without a doc’s scrip. They’ve even given it a cute little name; intermediate drugs. They make it sound like it’s not a baby drug like aspirin and not a big boy drug that can cross the street all by itself, but rather a drug that’s still deciding what it wants to be when it grows up. And until it decides, the FDA wants to make them available without a doc’s control. Like I said; cute.

Problem is, these drugs aren’t cute and don’t do cute things like make me talk funny after sucking up a helium balloon. They’re talking about statins and nasal steroids. WTF? I can’t even go to Costco and buy certain cold medicines without being given a body cavity search and my bra size because I might use them to cook meth.

Admittedly, I’m not a doc and don’t understand doc things, but in my limited brain capacity, I figure these drugs were made scrip only for a very good reason. So why the change? Well, it’s not because statins have suddenly become warm and fuzzy. This is being proposed to help those who can’t afford to visit a doc. Huh? Joe or Jane Patient can’t afford to go to a doc, so, hey, let’s let ‘em prescribe drugs for themselves, and, well, gee, big deal if there’s no one to measure their blood levels to make sure the dosage is right. Pharmacists will now be the new gatekeeper. Frankly, this scares the crap out of me.

I’m wondering just how far politics and government can go in order to dilute docs’ control of their patients. Whatever their goal, demoting big drugs to over the counter status just so “poor people” can get them is dangerous and idiotic. I wonder how my doc friends feel about this.


#1 Dinosaur said...

I think there are indeed some Rx drugs that don't need to be:

*Non-sedating antihistamines (Allegra, Zyrtec; they've already switched Claritin)
*Nasal steroids

I also think certain asthma meds (albuterol) ought to be available OTC, if for no other reason than to expedite access to them when people need them. Hey, it's no worse than Primatene mist (=adrenaline) in terms of cardiac risk. Same goes for controller meds like Advair and Singulair. Yes, they should be seeing their docs regularly, but I think erring on the side of greater access would decrease morbidity from "running out of meds."

On the other hand, in this day and age, I believe aspirin ought to be changed to Rx only. Leave the lower dose ibuprofen and naproxen OTC, but get the ASA the hell off the shelf.

I do not believe that meds to treat certain chronic disease (hypertension and hyperlipidemia, among others) should be OTC. Patients with those conditions should indeed be under a doctor's ongoing care.

Then again, I believe patients with certain conditions (like allergies and asthma) would benefit from the greater access implied by this new category.

mark a said...

Dino I agree with you on the anti histamines and perhaps even the nasal steroids but on controller asthma meds? While I agree that management of asthma for the vast majority of patients is relatively simple or at least I think so given the fact that there are national guidelines available and all.

Unfortunately, if I had a nickel for every "poorly controlled asthmatic" that I have seen who has absolutely no clue why they are on a controller medicine and just as many who have never been shown how to use the medicine, then I probably wouldn't be sitting here writing this comment. Or if I was I would be doing it from a nice Mahogany desk sitting in my Herman Miller Chair.

Seriously, asthma, much like diabetes management, requires that the patient has some basic understanding of the disease process and information as to why they require a controller medicine, even when they feel well.

Why is asthma any different from the other chronic conditions you mention, hypertension and hyperlipidemia? I certainly agree that albuterol is probably safer than Primatene mist, on the other hand most of those people buying those meds are at high risk of morbidity and mortality already because they probably do need some type of controller therapy.

#1 Dinosaur said...

Mark: I agree that asthmatics ought to be under medical care, but in this case, the accessibility issue trumps the paternalistic "I have to take care of you" piece.

Asthma is different, IMHO, because uncontrolled, it can kill a lot quicker than HTN or Diabetes.

mark a said...

I agree, but that is also the problem. Untreated it can kill, but overuse of beta agonists have also been associated with increased risk of death and hospitalizations.
Sadly the bigger issue all boils down to access, not to meds, or my paternalistic ways, but to healthcare itself and that is something too big for me to tackle.