FDA may let patients buy drugs w/o prescription

[duckie99]

http://www.washingtontimes.com/news...drugs-without-prescriptio/?page=all#pagebreak

does anyone else see a problem with this?

Pharmacists have a role in answering questions and helping with dosing certain medications but some sit around thinking docs don't know anything about the drugs they are prescribing, which of course is laughable. Pharmacists want the ability to sell their own meds for BP, DM, DL, etc with the patient just diagnosing themselves. I just don't see that as a good idea and there is no evidence to prove or even suggest that would be a good idea.

By the way I highly doubt the average american would go for this. To tell a person you just see a pharmacist and pick out and buy your own drugs with no involvement of a physician? I just don't believe a person would risk their health/life. I sometimes think the AMA doesn't argue against this stuff because they don't believe it'll happen. They just don't think a pharamacist will be managing a patient's diabetes. That is not their role. Never has been. They aren't trained to do that.

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[Morsetlis]

http://www.washingtontimes.com/news...drugs-without-prescriptio/?page=all#pagebreak

does anyone else see a problem with this?

I think it works out okay so far for all the other countries that are doing it.

 

[duckie99]

I think it works out okay so far for all the other countries that are doing it.

ok... which countries? and what evidence can you cite to prove your statement? What peer-reviewed papers can you link us to? Thanks

 

[Morsetlis]

I don't care to support my position, sorry.

*goes watch Game of Thrones*

 

[jcu]

*goes watch Game of Thrones*

Amazing episode. You'll enjoy it.

 

[SpecterGT260]

thread redundancy between allo and pre-allo is kinda crazy some times....

I think this is a ridiculous idea.... Some drugs could go this way, but not BP meds and not for a large number of BP patients.

 

[CaptainSSO]

Doesn't seem like a bad idea to me.

 

[SpecterGT260]

why not?

 

[cowme]

I see no problem with this. Sure, there are side effects with every medication. But most bp mess are no more harmful than Mortin and Tylenol.

 

[surftheiop]

This would seem to make sense for some drugs (I'm not knowledgeable to know which at this point), PharmD's learn a ton of stuff over the course of their schooling and it seems weird that the ones doing retail are still doing the same job you used to be able to do with a bachelors degree. And as someone else above mentioned, in a lot of places pharmacists have more prescribing power (or at least there are more OTC drugs available for them to advise you on).

As far as I can tell the biggest danger for morbidity/mortality when prescribing drugs would be related to a drug to drug interaction or possible adverse effects, which I'm sure pharmacists are probably actually more knowledgeable about than the average MD. (This obviously isn't bashing us, I'm in medschool haha)

 

[RafaTech]

This is a terrible idea. We already have growing antibiotic resistance, now lets just let the everyday Joe access antibiotics for their everyday cold and lets see how fast we get multidrug resistance bacteria. Then we're all screwed. Also, with things like diabetes medications, there are common side effects that can make certain drugs bad in populations and potentially life threatening. Is the pharmacist going to have time to manage and adjust every diabetic person that has a hypoglycemic episode on their sulfonylurea? Who is going to follow their HbA1c and make sure they are compliant and adjust their meds? Who is going to tell that person with high blood pressure that they should be taking an ACE inhibitor for their microalbuminuria when the patient probably doesnt even know they have diabetes? Sure pharmacist are great at knowing drug interactions and indications for diseases, but they are not diagnosticians....

 

[Marcus Brody]

I am all for the legalization of healthcare.

The only people threatened by this are those that wield arbitrary power acquired by force and coercion, ie: bureaucrats, politiicans, administrators and sh*tty doctors.

 

[auburnO5]

This is a terrible idea. We already have growing antibiotic resistance, now lets just let the everyday Joe access antibiotics for their everyday cold and lets see how fast we get multidrug resistance bacteria. Then we're all screwed. Also, with things like diabetes medications, there are common side effects that can make certain drugs bad in populations and potentially life threatening. Is the pharmacist going to have time to manage and adjust every diabetic person that has a hypoglycemic episode on their sulfonylurea? Who is going to follow their HbA1c and make sure they are compliant and adjust their meds? Who is going to tell that person with high blood pressure that they should be taking an ACE inhibitor for their microalbuminuria when the patient probably doesnt even know they have diabetes? Sure pharmacist are great at knowing drug interactions and indications for diseases, but they are not diagnosticians....

Pretty much this.


It'll never happen.

 

[awval999]

Terrible idea, and I'm a pharmacist.

And it's not that pharmacists couldn't do this, it's that the chains would make a bastardization of whatever process came about. I don't even see the logistics of this. Furthermore, greater than 50% of the pharmacist labor pool is soley a BPharm with no added education.

If anything it would have to start very small in test sites for example, and even then I would only trust BCPS certified pharmacists for this role; as it's de-facto prescribing.

So for me to consider this I'd want pharmacists with their PharmD with BCPS certification (ambulatory care or pharmacotherapy), in addition the site, ie: Walgreens/CVS having a private office for these consultations, lab reviews, etc. Laws would also have to be changed. Yadda yadda.

 

[auburnO5]

Terrible idea, and I'm a pharmacist.

And it's not that pharmacists couldn't do this, it's that the chains would make a bastardization of whatever process came about. I don't even see the logistics of this. Furthermore, greater than 50% of the pharmacist labor pool is soley a BPharm with no added education.

If anything it would have to start very small in test sites for example, and even then I would only trust BCPS certified pharmacists for this role; as it's de-facto prescribing.

So for me to consider this I'd want pharmacists with their PharmD with BCPS certification (ambulatory care or pharmacotherapy), in addition the site, ie: Walgreens/CVS having a private office for these consultations, lab reviews, etc. Laws would also have to be changed. Yadda yadda.

Right.

If only there was some profession where the worker could analyze the labs, have their own private office, consult the patient, make a diagnosis, and prescribe them drugs.... Imagine how nice that would be. Crazy idea though, I know.

 

[awval999]

Right.

If only there was some profession where the worker could analyze the labs, have their own private office, consult the patient, make a diagnosis, and prescribe them drugs.... Imagine how nice that would be. Crazy idea though, I know.

I lol'd.

 

[auburnO5]

I lol'd.

Haha I wasn't taking a shot at you, just btw. I think it's funny that all of these groups are trying to gain more doctor privileges... When they just should have become doctors in the first place - and I'm referring more to NP's..

I would say in general, pharmacists do know more about drugs, however there is no practical way for them to become prescribers.

 

[Perrotfish]

This is a terrible idea. We already have growing antibiotic resistance, now lets just let the everyday Joe access antibiotics for their everyday cold and lets see how fast we get multidrug resistance bacteria. Then we're all screwed..

We let every dairy farmer feed their cows antibiotics by the shovel full and every soap company mix antibiotics with their lavendar sent. This seems like a strange place to draw the line.

Is the pharmacist going to have time to manage and adjust every diabetic person
that has a hypoglycemic episode on their sulfonylurea? Who is going to follow
their HbA1c and make sure they are compliant and adjust their meds? Who is going
to tell that person with high blood pressure that they should be taking an ACE
inhibitor for their microalbuminuria when the patient probably doesnt even know
they have diabetes? Sure pharmacist are great at knowing drug interactions and
indications for diseases, but they are not diagnosticians

Most of the patients in this country are managed by urgent cares and ERs (if at all) and the FPs are already saturated. Even when we get them in contact with someone who can perscribe the correct drugs they don't actually take them because they can only afford whatever is on the $4 list at Walmart, which is why most of the type one diabetics in this country are still on NPH and regular insulin. I think there's a good chance things would get better rather than worse if they could just get around us entirely and buy the drugs from the store.

 

[auburnO5]

We let every dairy farmer feed their cows antibiotics by the shovel full and every soap company mix antibiotics with their lavendar sent. This seems like a strange place to draw the line.



Most of the patients in this country are managed by urgent cares and ERs (if at all) and the FPs are already saturated. Even when we get them in contact with someone who can perscribe the correct drugs they don't actually take them because they can only afford whatever is on the $4 list at Walmart, which is why most of the type one diabetics in this country are still on NPH and regular insulin. I think there's a good chance things would get better rather than worse if they could just get around us entirely and buy the drugs from the store.

Except for the fact that this would inevitably create many million dollar lawsuits after uncle Billy went into a hypoglycemic coma or Suzy died from severe lactic acidosis. Who gets sued then? Pharmacists? Drug companies?

 

[Perrotfish]

Except for the fact that this would inevitably create many million dollar lawsuits after uncle Billy went into a hypoglycemic coma or Suzy died from severe lactic acidosis. Who gets sued then? Pharmacists? Drug companies?

Perhaps this would be a step towards people taking responsiblity for their actions? If you choose to represent yourself in court and lose you can't sue anyone for legal malpractice, so if you come up with your own medical regimin you shouldn't be able to sue anyone for medical malpractice.

 

[auburnO5]

Perhaps this would be a step towards people taking responsiblity for their actions? If you choose to represent yourself in court and lose you can't sue anyone for legal malpractice, so if you come up with your own medical regimin you shouldn't be able to sue anyone for medical malpractice.

I guess I agree with that.

Again, if only there were some people with a broad knowledge base who knew how to competently manage diseases and also had prescribing power. Maybe one day, right?

 

[awval999]

Haha I wasn't taking a shot at you, just btw. I think it's funny that all of these groups are trying to gain more doctor privileges... When they just should have become doctors in the first place - and I'm referring more to NP's..

I would say in general, pharmacists do know more about drugs, however there is no practical way for them to become prescribers.

Auburn, the problem is that we have a large segment of society that is truly incapable of self-sufficiency. Truly they just subsist from the taxes that you and I pay. We (the taxpayers) cannot pay for them forever. At least not at the cost of ER stays, etc, etc. Maybe if the welfare largesses could just get mouthfuls of metformin and atorvastatin with a quarterly blood test then healthcare expenditures could be cheaper? I dunno honestly.

I am a pharmacist. I will never go to a NP. I can afford a MD. I only go to MD's. Honestly, I only go to American born and American educated MD's. I only go to private practice dentists. With fancy offices. None of that Aspen Dental for me. It's just what I do. It's how I choose to spend my money.

But I know there are Americans that cannot afford that luxury. And it is those Americans that are crushing the rest of us with food stamps, Medicaid, etc. They will have to be managed by NP's, PA's, and those annoying pharmacists, it's probably just what will have to happen.

 

[surftheiop]

If you walk into many CVS's now they have a "minute clinic" set up where they have a NP that can write you a script to get filled by the pharmacist. I think its actually a pretty good idea*, but I don't see why its any better than just letting the pharmacist give out certain prescriptions.

*(Given the liability CVS is taking on by having a provider there, I'm sure they have super specific guidelines on the NP's scope of practice b/c CVS has a lot to lose financially in a big lawsuit).

 

[armybound]

how is someone going to be diagnosed as hyperlipidemic if they haven't seen a doctor to be tested? are pharmacists going to be in the business of examining patients and running labs for free?

who's going to handle the responsibility of figuring out if Mrs. Johnson is hypertensive because she's just getting older or if she's got a hot nodule or if she's got a pheo or if she's anxious or if the stupid sphygmo she's been using is too small for her arm?

 

[auburnO5]

who's going to handle the responsibility of figuring out if Mrs. Johnson is hypertensive because she's just getting older or if she's got a hot nodule or if she's got a pheo or if she's anxious or if the stupid sphygmo she's been using is too small for her arm?

Pharmacists brah

 

[awval999]

how is someone going to be diagnosed as hyperlipidemic if they haven't seen a doctor to be tested? are pharmacists going to be in the business of examining patients and running labs for free?

who's going to handle the responsibility of figuring out if Mrs. Johnson is hypertensive because she's just getting older or if she's got a hot nodule or if she's got a pheo or if she's anxious or if the stupid sphygmo she's been using is too small for her arm?

Exactly. Pharmacists are not diagnositicans. I don't really see how this ever takes off imo. Then again we have nurses with prescriptive authority so I don't know how that happened either.

 

[rad0nc]

http://www.washingtontimes.com/news...drugs-without-prescriptio/?page=all#pagebreak

does anyone else see a problem with this?

I think it is a good idea as long as the stewardship of antibiotics is maintained. In fact the pharmacists that I have rounded with seem to be much more up to date on antibiotic stewardship issues than physicians.

 

[SpecterGT260]

I just want to see proper liability across the board for any other practitioner that wants to expand practice. The whole situaiton is irritating until pharmacists, PAs, and DPNs are getting sued when they want to take the lead and screw up.

 

[surftheiop]

I just want to see proper liability across the board for any other practitioner that wants to expand practice. The whole situaiton is irritating until pharmacists, PAs, and DPNs are getting sued when they want to take the lead and screw up.

I don't see why they wouldn't be sued under current laws if they are actually practicing independently. I think the reason you don't hear of many lawsuits is because there really are not that many NP's that are actually practicing independently, and the ones that are, do so in a way to minimize liability by carefully controlling their scope of practice. (Which is exactly how it should be)

 

[SpecterGT260]

I don't see why they wouldn't be sued under current laws if they are actually practicing independently. I think the reason you don't hear of many lawsuits is because there really are not that many NP's that are actually practicing independently, and the ones that are, do so in a way to minimize liability by carefully controlling their scope of practice. (Which is exactly how it should be)

you are probably right - but I interpret that to mean that incidences go under the radar. I also don't know that all of the proper systems are set up to handle it. Not many hospitals likely to shell out to cover a DNP I suspect. I could be wrong.... The current system puts the physician in harms way if something happens and if other people want to sit at the grownup's table then it needs to be made clear that the buck stops with them and not some arbitrary physician who on paper in higher on the totem pole

 

[sportsperson]

The general population doesn't even have a half-decent idea of basic bodily functions, let alone drug mechanisms and interactions.

Makes perfect sense to do this..../sarcasm

 

[giantswing]

Given people's ability to control themselves against excess food/alcohol/drugs anyway, this can only go well.

 

[SpecterGT260]

actually just got off the phone with my dad who is a surgeon. Said he had to deal with a local chiropractor and RNP who were performing fluoroscopy and spinal anesthetic injections. Completely missed a herniated disc and was treating it with proximal spinal injections. anecdotal? yes. but still.... Raise your hands if you would attempt to treat a slipped disc this way

 

[Rendar5]

DM drugs - patient takes a couple, unsure of the severity of their diabetes, or self-diagnoses DM when they dont' have it (I get at least one pt a month who swears they have diabetes because they're peeing a lot. they actually have a UTI, or they're somaticizers). That = ED visits and 24hr hospitalizations for hypoglycemia.

I'd be ok with BP meds as long as they were only mild ones that would be difficult to overdose on, like norvasc or HCTZ.

 

[dr zaius]

Exactly. Pharmacists are not diagnositicans. I don't really see how this ever takes off imo. Then again we have nurses with prescriptive authority so I don't know how that happened either.

Nurses actually care for the patient. Doctors are cold-hearted yacht owners who only care about money and being god. Nurses earned that prescribing power by proving that they can do the job just as well as a physician while still being super caring. The Professional Nursing Journal also featured a study that showed medical knowledge and desired patient outcomes are directly proportional to gluteal size. It's only a matter of time before nurses are manning pharmacies as well. The writing is on the wall.

 

[SpecterGT260]

Nurses actually care for the patient. Doctors are cold-hearted yacht owners who only care about money and being god. Nurses earned that prescribing power by proving that they can do the job just as well as a physician while still being super caring. The Professional Nursing Journal also featured a study that showed medical knowledge and desired patient outcomes are directly proportional to gluteal size. It's only a matter of time before nurses are manning pharmacies as well. The writing is on the wall.

I get a yacht?

 

[surftheiop]

actually just got off the phone with my dad who is a surgeon. Said he had to deal with a local chiropractor and RNP who were performing fluoroscopy and spinal anesthetic injections. Completely missed a herniated disc and was treating it with proximal spinal injections. anecdotal? yes. but still.... Raise your hands if you would attempt to treat a slipped disc this way

If these providers harmed the patient they could be sued the same way as if a MD harmed the patient. Pointing to random anecdotal negligence/malpractice doesn't really help anyone's cause because tons of MD's make huge mistakes everyday and the last thing we need is people thinking MD's can't be trusted b/c of the bad apples.

 

[SpecterGT260]

If these providers harmed the patient they could be sued the same way as if a MD harmed the patient. Pointing to random anecdotal negligence/malpractice doesn't really help anyone's cause because tons of MD's make huge mistakes everyday and the last thing we need is people thinking MD's can't be trusted b/c of the bad apples.

man, if only I had thought to admit up front that it was anecdotal.....

 

[hrandani]

The Professional Nursing Journal also featured a study that showed medical knowledge and desired patient outcomes are directly proportional to gluteal size.

 

[SteinUmStein]

actually just got off the phone with my dad who is a surgeon. Said he had to deal with a local chiropractor and RNP who were performing fluoroscopy and spinal anesthetic injections. Completely missed a herniated disc and was treating it with proximal spinal injections. anecdotal? yes. but still.... Raise your hands if you would attempt to treat a slipped disc this way

Ironically, chiropractors are the last people who should be anywhere near the spine. Why can't they be fingerpractors or kneepractors so they can work their voodoo magic without doing serious or potentially irreversible damage.

 

[SpecterGT260]

Ironically, chiropractors are the last people who should be anywhere near the spine. Why can't they be fingerpractors or kneepractors so they can work their voodoo magic without doing serious or potentially irreversible damage.

the problem is, in the already hazy and indistinct origins of their practice, they are seem evolve about as sporadically and irrationally as their doctrine (dogma?).
This guy was apparently passing himself off as a "pain doctor" which - yes, most chiropractic treatments are designed to treat pain (just like about everything Wiley Coyote bought was designed to catch the Roadrunner) but this does not suddenly make one an anesthesiologist....

 

[Marcus Brody]

how is someone going to be diagnosed as hyperlipidemic if they haven't seen a doctor to be tested? are pharmacists going to be in the business of examining patients and running labs for free?

who's going to handle the responsibility of figuring out if Mrs. Johnson is hypertensive because she's just getting older or if she's got a hot nodule or if she's got a pheo or if she's anxious or if the stupid sphygmo she's been using is too small for her arm?

Why not? Do you have something against efficiency?

 

[SpecterGT260]

how is someone going to be diagnosed as hyperlipidemic if they haven't seen a doctor to be tested? are pharmacists going to be in the business of examining patients and running labs for free?

who's going to handle the responsibility of figuring out if Mrs. Johnson is hypertensive because she's just getting older or if she's got a hot nodule or if she's got a pheo or if she's anxious or if the stupid sphygmo she's been using is too small for her arm?

the true answer (at least in my opinion) is that nobody will. Patient populations will be boiled down to their EBM stats and the auto-scripts will come out as a result of an "odds are" sort of diagnosis. Sucks for the non-gamblers and people who dont like playing the odds.

protocols and flowcharts are already overly prevalent in medicine.... "if he has A,B, and C then it is _____, if A and C but not B then it is _____" Fine for efficiency purposes and quick recall, but there is a major problem with relying on such diagnostic methods rather than understanding the disease processes and WHY the patient has the specific combination of findings. A pharmacist will not know this.

 

[awval999]

Nurses actually care for the patient. Doctors are cold-hearted yacht owners who only care about money and being god. Nurses earned that prescribing power by proving that they can do the job just as well as a physician while still being super caring. The Professional Nursing Journal also featured a study that showed medical knowledge and desired patient outcomes are directly proportional to gluteal size. It's only a matter of time before nurses are manning pharmacies as well. The writing is on the wall.

Nurse pharmacy practioners. Love it.

 

[Bacchus]

If these providers harmed the patient they could be sued the same way as if a MD harmed the patient. Pointing to random anecdotal negligence/malpractice doesn't really help anyone's cause because tons of MD's make huge mistakes everyday and the last thing we need is people thinking MD's can't be trusted b/c of the bad apples.

Just an aside to this because one of my OMM professor harps on it...

Both he, and chiropractors, do physical manipulation. However, because he can practice medicine his malpractice rate is 10-11X the chiropractor's who does many of the same shared techniques of the physical medicine worlds.

 

[Marcus Brody]

Something to think about...

[FONT=Times New Roman, Times, serif] Let us assume that your physician informs you that you have cancer. The type of cancer that you have is invariably fatal. He utters those words that estate planning lawyers thrive on: "You should get your affairs in order.".

[FONT=Times New Roman, Times, serif] You go home. After thinking about your situation, you go online in search of a solution. You come across an article on a proposed new cure. There is hope. But you find that the cure is experimental. It has not been approved by the Food and Drug Administration. The estimated cost of getting through the FDA's legal hoops is $100 million. It will take seven years..

[FONT=Times New Roman, Times, serif] You do not have seven years..
[FONT=Times New Roman, Times, serif]
Do you believe in free trade in proposed cancer cures? Now you do..
[FONT=Times New Roman, Times, serif]
What if you could sign a legal waiver taking full responsibility for your actions? What if you are willing to let the discoverer off the hook legally for any negative outcome of the treatment? Sorry, no-can-do. That would be illegal.

. [FONT=Times New Roman, Times, serif] Why would it be illegal?.
[FONT=Times New Roman, Times, serif]
There is a simple reason: "Because it would reduce the power of the Food and Drug Administration." If every Tom, Dick, and Harry were willing to sign a waiver, then the FDA could not control drugs. This degree of open entry into the health care field would enable producers of health-care to get together with customers to arrange mutually agreeable solutions.

. [FONT=Times New Roman, Times, serif] But wouldn't this open the door to quacks? Yes. Wouldn't this open the door to snake-oil salesmen? Yes. Wouldn't this expose the public to scientifically unsubstantiated claims made by profit-seeking charlatans? Yes. Then why should the government allow it? Because this allows the free flow of ideas. By "free flow" I do not mean zero-cost. I mean legally unrestricted, as in "I get to think this. I also get to share my ideas. Someone else gets to think it, too.".
[FONT=Times New Roman, Times, serif]
"Of course," says the Congress of the United States. "You may think anything you want. Just don't ask anyone to pay you for your idea. To get paid for your idea, you must be licensed by the federal government.".
[FONT=Times New Roman, Times, serif]
At every level of civil government, there are politicians who pass laws and legally tenured bureaucrats to enforce them. One purpose of these laws is to restrict the free flow of ideas. Another is to create monopolies for large corporations with teams of lawyers. These firms have the money to get through the hoops established by the bureaucrats..
[FONT=Times New Roman, Times, serif]
Some of the senior bureaucrats then retire with full pension benefits and go to work for the corporations that are the beneficiaries of the regulations written and enforced by the bureaucracy..
[FONT=Times New Roman, Times, serif]
This is normal. We know it's normal. We are told that this is the price the public must pay to secure safety..
[FONT=Times New Roman, Times, serif]
Safety from what? Safety from the free flow of ideas..
[FONT=Times New Roman, Times, serif]
Cancer cells do not have a lobby in Washington. They do not need one. But if they did have one, why would it promote laws different from what we now have?.

[FONT=Times New Roman, Times, serif]
.

 

[SpecterGT260]

This is a little extreme. Non terminal patients signing away rights will burden the system. "I just KNOW I have lymphoma! I itch!" (Real story from an acquaintance) but do we let this person rot once they incur side effects from unnecessary chemo?
Allegedly and hypothetically they have signed away their rights

 

[TallScrubs]

I'm going to just start telling random people on the streets to use Dig for their colds....

 

[FunnyCurrent]

Why not just take the drugs with large therapeutic index and make it OTC. That way we cut out the middle man (pharmacists) and perhaps save some costs.

Q: "but we need someone to consult, follow the patient, and make sure the dosage and drug is appropriate"

A: Right, that would be the doctors

 

[Morsetlis]

This is a little extreme. Non terminal patients signing away rights will burden the system. "I just KNOW I have lymphoma! I itch!" (Real story from an acquaintance) but do we let this person rot once they incur side effects from unnecessary chemo?
Allegedly and hypothetically they have signed away their rights

Do you have cancer?



We already know that one policy doesn't fit all. The goal is to move toward a more fitting policy for people to manage their own lives in the case that a physician is either not available, or not cheaply available.