Medical Doctors / General Practitioners

[geni]

The other issue is that doctors provide a reporting system of sorts so you can pick up the side effects that initial testing missed.

 

[geni]

And this isn't an ailment, but a case could be made for oral contraceptives.

Those have known and significant side effects. Still trials are takeing place in I think parts of london to make it OTC. We shall see.

 

[Miss_Kitt]

That's why I made a special note about antibiotics. But it is ironic that it's OK to hurt yourself with aspirin or alcohol or even herbal supplements, but you are not allowed to make an informed decision on other safer medications.

I agree. I think it is ridiculous that herbal supplements are not required to meet the same standard of demonstrating effect and showing no or trivial side effects, that OTC meds are. Alcohol, however (at least where I live), is a controlled substance. You have to be 21 or older to buy it, and you will be refused service if you are obviously drunk.

I generally agree, but more often than not, in my experience, visiting a doctor is a waste of time and money, as I can predict what they will prescribe and why.

I certainly wouldn't try or want to avoid the doctor if the problem is outside the scope of my knowledge. But I guess we can't all be held responsible for our actions.

The issue is, of course, that without a fair amount of medical background, you cannot know when it's what you have had before, and when it is not. My husband was convinced that his appendecitis was Revenge of The Thai Food, and only went to a doctor because I dragged him.

The discussion of whether or not the government should be controlling access to drugs, rather than letting people kill themselves by guessing wrong, is rather a complicated one. The FDA was and is supposed to be a benefit of being a citizen, rather than an onus.


On another post, you comment that your doctor won't see you because you owe him money. In which case, it is neither the doctor nor the law which is causing you the problem, but rather that you didn't pay your bill. I understand that circumstances occur where bills go unpaid or partially paid; but that is a very different issue than referring to a "doctor tax" on prescription meds. It would appear that you are indeed being held responsible for the results of your actions: Had you paid your doctor bill, you would not be in this pass. Apparently, you have money for the prescription, but not your doctor? Is there a friend you can turn to, or a discounted drug program? (Most pharmaceutical companies have them, especially for products that have no generic, are expensive, and are for ongoing conditions.)

Just my thoughts, MK

 

[gdnp]

Shouldn't there be some way to avoid paying an "electirician tax" every time I need wiring done in my house?

I'm not saying electricians are useless (OK, maybe a little bit), but if you have no extra money, and you think you are experienced enough with wiring and/or educated enough with electronics, shouldn't you be allowed to rewire your house?

Now please repeat regarding plumbers, engineers, airplane pilots, or any other profession that requires specific training and licensure.

Certainly an argument could be made that some drugs that are now sold only by prescription are safe enough that they should be sold over the counter. I suspect that you will find that the main impediment to this being done is drug companies, not physicians.

 

[Richard Masters]

Shouldn't there be some way to avoid paying an "electirician tax" every time I need wiring done in my house?

I'm not saying electricians are useless (OK, maybe a little bit), but if you have no extra money, and you think you are experienced enough with wiring and/or educated enough with electronics, shouldn't you be allowed to rewire your house?

That's a terrible analogy since you can rewire your house.

Now please repeat regarding plumbers, engineers, airplane pilots, or any other profession that requires specific training and licensure.

Your analogy is intellectually dishonest and fails.

Certainly an argument could be made that some drugs that are now sold only by prescription are safe enough that they should be sold over the counter. I suspect that you will find that the main impediment to this being done is drug companies, not physicians.

Please elaborate.

 

[Richard Masters]

On another post, you comment that your doctor won't see you because you owe him money. In which case, it is neither the doctor nor the law which is causing you the problem, but rather that you didn't pay your bill.

Not quite. It's a very simple chicken or egg question. I've spent over 1500 dollars on doctor visits alone for this particular doctor. I owe my doctor 130 dollars.

If I hadn't had to see a doctor to get a medication that I could have picked myself, this wouldn't have happened in the first place.

I understand that circumstances occur where bills go unpaid or partially paid; but that is a very different issue than referring to a "doctor tax" on prescription meds.

I think you are missing the point. You seem to be blaming the victim here.

I could easily pay my doctor if I could afford the medication.

I could have better spent that money on rent or even the medication itself. What service did this doctor provide besides a signature?

It would appear that you are indeed being held responsible for the results of your actions: Had you paid your doctor bill, you would not be in this pass. Apparently, you have money for the prescription, but not your doctor?

Like I said, you are blaming the victim.

Correct. I have money for a similar prescription ($50) but not for the doctor visit ($160).

Is there a friend you can turn to, or a discounted drug program? (Most pharmaceutical companies have them, especially for products that have no generic, are expensive, and are for ongoing conditions.)

The discounted medication costs $130. So, no. I've already borrowed money from friends and family to pay for rent, medications, etc.

 

[Richard Masters]

I suspect that you will find that the main impediment to this being done is drug companies, not physicians.

How about the FDA?

Would it be wrong to falsify a request for prescription I need? Illegal, maybe, but wrong?

Why or why not?

 

[drkitten]

Would it be wrong to falsify a request for prescription I need? Illegal, maybe, but wrong?

Well, it would be stupid, but that's not necessarily "wrong." Personally, I'm in favor of stupid people killing themselves with drugs that they don't understand. Average human intelligence goes up by a fraction of a percent.

The basic problem with this whole idea is that the people who are the most likely to make mistakes are the least likely to believe that they might make mistakes. While you, personally, may have the equivalent of a self-taught M.D. and Ph.D. in pharmacy (although you must admit the odds are against that), consider the problem of my idiot cousin who believes that bathroom grout is a suitable adhesive for building material, and therefore considers the local building code to be a conspiracy of carpenters.

In theory at least, the reason that drugs are not available OTC is because there's either too high a risk they will be abused, or there's too high a risk they will be misused. People are notorious for presenting the same (or similar) symptoms for all sorts of underlying reasons, and if you take a drug for something "because you've had this before" you may well be taking the wrong drug for a completely different reason. And the worse your judgement, the more stubbornly you are likely to hold onto your wrong and dangerous ideas.

Now, we can argue about lots of drugs that should be OTC and aren't,... but I'm perfectly happy with the idea that my cousin, who knows as much about medicine as he does about carpentry, isn't trying to diagnose for his children.

(Oh, why aren't doctors subject to this, you ask? Well,... they are. That's why doctors are required to pass tests in medical school, pass boards, and get CMA credits throughout their careers. The ones who are too incompetent to know how incompetent they are are the ones who wash out, because other people will forcibly remove them from the profession.)

 

[Miss_Kitt]

Mr. Masters, what state do you reside in? More specifically, what kind of public health programs are available? It sounds like you have no insurance, but I am surprised that you have a doctor that charges you $160 for an office call that requires nothing but a meds check. I don't know what condition you have or what kind of screening is required, but the amount suggests to me it's a bit more than just a follow-up.

Be that as it may, there are federal and (usually) state programs that provide for reduced-cost insurance and/or healthcare. If you are unable to pursue your living because of your medical condition, there may be additional benefits available through SSA as well.

I have been in the situation of owing a doctor some serious money, but as long as I was making monthly payments she was fine with occasionally seeing me anyway. YMMV, of course, but I wonder how you can have seen this doctor for most of a year (assuming $160 per visit) and your condition is not significantly improved?

Another possibility is that the nature of the medication makes it susceptible to abuse, in which case doctors have to really justify that the med is needed before they write the prescription. Again, since I have no specifics (and of course you are perfectly within your rights to guard your privacy) I am to some degree hampered in making suggestions.

You earlier suggested a scenario where you could "easily find a medication with the same interaction profile and a similar mechanism of action" to use, but also say that the product has no generic. Hmm. If there is another, cheaper, drug available, what did your doctor say when you suggested it? Have you actually found such a drug?

I'm a little confused now between your hypothetical argument and your real-world circumstance, so forgive me if I'm asking too many questions.

Also, are you in a town with only one doctor? I have not lived in a place so rural that another doctor was not within a 45 minute drive, so changing physicians was always an option. Again, it might be worth looking into public health options as well. I recently got more immunizations than I care to list through the local PH clinic, and they were both professional and fairly inexpensive. (I am starting school in a healthcare-related field, so I have to meet the standards for healthcare worker immunization status. Ouch!)

I do feel for your quandry, though. I have a dear friend who has to take several meds to keep her mental health together, and when she was unemployed recently it was very tough for her. She was able to prevail upon a doctor to give her a 'courtesy' prescription because he had treated her before and knew that she really needed her meds to be able to look for work! (We picked up the cost of her meds one month, so I know it can be a big expense.) She has moved to a new area and is working again, for which we are all very happy.

Hang in there, hopefully you'll catch a break. -- MK

ETA -- I am a little concerned by your use of the phrase "blaming the victim". I do not regard you as a victim; no crime has been committed here. Nor am I blaming you. I am pointing out that the logic you apply to "letting the chips fall where they may" if people take inappropriate medications under a non-Rx regime, also applies to the financial issue you are facing. In both cases, good intentions do not equal good results--but in the case of a mistaken medication use, the result could be not an empty wallet, but a full grave.

 

[gdnp]

That's a terrible analogy since you can rewire your house.

Really? I didn't know that. I guess electricians licenses are optional. I wonder why electricians bother getting them

Your analogy is intellectually dishonest and fails.

Intellectually dishonest? I thought it was quite apt. We require electricians to be licensed because faulty wiring causes fires. We require plumbers to be licensed because we don't want pipes to leak and cause damage and health problems.We require engineers to be licensed so the bridges they build don't fall down. We require pilots to be licensed so they don't crash planes.

Certain drugs are restricted because they are dangerous when misused or even when used properly. Prescription drugs kill thousands of people a year. It is also dangerous for someone to use a drug to treat a symptom of a disease that has not been properly diagnosed. "Oh, that bleeding is just my colitis. It happens all the time. I'll just take some drugs I learned about on the internet". Whoops. It was cancer. Now it's metastatic. Too late.

Please elaborate.

Why would you be interested in elaboration by someone who is intellectually dishonest?

 

[Richard Masters]

Well, it would be stupid, but that's not necessarily "wrong." Personally, I'm in favor of stupid people killing themselves with drugs that they don't understand.

Me too.

The basic problem with this whole idea is that the people who are the most likely to make mistakes are the least likely to believe that they might make mistakes.

I agree. I'm quite familiar with cognitive dissonance, medical student syndrome, and the fact that on average, people think they are better than average.

While you, personally, may have the equivalent of a self-taught M.D. and Ph.D. in pharmacy (although you must admit the odds are against that), consider the problem of my idiot cousin who believes that bathroom grout is a suitable adhesive for building material, and therefore considers the local building code to be a conspiracy of carpenters.

The odds are against that for sure. But I do have five years of experience with my symptoms, which is more than any doctor; and I do have formal education in Psychology and Neuropsychology.

BTW, I don't think there is a conspiracy here (not that you were implying so). I just know that the situation is very unfair for this set of circumstances.

In theory at least, the reason that drugs are not available OTC is because there's either too high a risk they will be abused, or there's too high a risk they will be misused.

That's true, but my case, that's a risk I'm willing to take. Since my doctor can't take that risk for economic reasons, I should be allowed to, for the same reasons.

People are notorious for presenting the same (or similar) symptoms for all sorts of underlying reasons, and if you take a drug for something "because you've had this before" you may well be taking the wrong drug for a completely different reason. And the worse your judgement, the more stubbornly you are likely to hold onto your wrong and dangerous ideas.

True, but nobody has offered a better solution.

Now, we can argue about lots of drugs that should be OTC and aren't,... but I'm perfectly happy with the idea that my cousin, who knows as much about medicine as he does about carpentry, isn't trying to diagnose for his children.

So am I, but only from your description. If the opposite were the case, I would have to disagree.

(Oh, why aren't doctors subject to this, you ask? Well,... they are. That's why doctors are required to pass tests in medical school, pass boards, and get CMA credits throughout their careers. The ones who are too incompetent to know how incompetent they are are the ones who wash out, because other people will forcibly remove them from the profession.)

Like I said, doctors have their place. This isn't an argument against doctors per se. I'm arguing against petty formalities as such. It's a waste of time and money when doctors are relegated to writing prescriptions.

One of my college professors who had diabetes and other complications often did far more research than his doctors. They would be stumped; he'd suggest a medication he had researched, explain his reasoning, and the doctors would dogmatically accept the fact that they couldn't come up with a better solution before the next patient came in.

It's insulting to pretend that only doctors understand medical advances or medical studies. It's not as if the public statically believes in blood-letting while doctors advance their knowledge exponentially in comparison.

I've actually found myself finishing sentences for general practitioners. I have access to the same information, and more importantly, I'm actively researching my conditions.

If I ever have intestinal problems or something I don't understand, I will value and gladly pay for a doctor visit. I've found, however, that general practitioners have no idea when it comes to mood disorders.

One I saw recently, in particular, explicitly emphasizes "natural cures" (herbal cures) and "alternative medicine". Somebody cheated on their medical exams...

On another note, I think in the UK pharmacologists are allowed to sell you prescription medications. That seems like a fair compromise.

 

[gdnp]

How about the FDA?

Would it be wrong to falsify a request for prescription I need? Illegal, maybe, but wrong?

Why or why not?

The drug companies and the FDA decide what drugs will be prescription only and which will be OTC. This is out of my area of specialty (I don't even prescribe drugs), but I suspect that it is the drug manufacturer who requests that a prescription drug be made available over the counter. This is often done at a reduced dose, which seems a bit silly to me: OTC motrin is 200 mg, while prescription motrin is 400, 600, or 800 mg. There is nothing to stop someone form taking 4 200 mg tablets and getting the "prescription" 800 mg dose.

If I am not mistaken, several drugs like Zantac have become available over the counter just after they come off patent. I suspect the manufactureres choose to make up in volume what they lose when their monopoly ends.

 

[Richard Masters]

Really? I didn't know that. I guess electricians licenses are optional. I wonder why electricians bother getting them.

My guess is it has something to do with the law, and not some magical property of the license. Are you seriously suggesting that people are incompetent to solve problems if they don't have licenses? If so, that's a false dilemma.

Intellectually dishonest? I thought it was quite apt. We require electricians to be licensed because faulty wiring causes fires. We require plumbers to be licensed because we don't want pipes to leak and cause damage and health problems.We require engineers to be licensed so the bridges they build don't fall down. We require pilots to be licensed so they don't crash planes.

I know people who do their own plumbing, rewire their own homes and so on. More importantly, I'm not familiar with any laws which require them to get permission from a plumber or an electrician to buy plumbing supplies. Last time I checked, you didn't have to get permission from a pilot to buy a plane.

Last time I checked, you didn't have to purchase a visit with a mechanic to upgrade or fix your car.

Certain drugs are restricted because they are dangerous when misused or even when used properly. Prescription drugs kill thousands of people a year.

And illegal drugs kill fewer people.

It is also dangerous for someone to use a drug to treat a symptom of a disease that has not been properly diagnosed.

Common knowledge.

It is also dangerous for someone not to take a medication for something that has already been diagnosed.

"Oh, that bleeding is just my colitis. It happens all the time. I'll just take some drugs I learned about on the internet". Whoops. It was cancer. Now it's metastatic. Too late.

A very close relative of mine had the opposite happen. She went to a doctor who kept saying her complaints were psychosomatic and treated her like an idiot. Months later when she went to the emergency room it turned out to be cancer. She could have avoided several major surgeries if the doctor had taken her more seriously on time.

Why would you be interested in elaboration by someone who is intellectually dishonest?

I thought your analogy was intellectually dishonest. Maybe I misattributed your intentions.

 

[Richard Masters]

The drug companies and the FDA decide what drugs will be prescription only and which will be OTC. This is out of my area of specialty (I don't even prescribe drugs), but I suspect that it is the drug manufacturer who requests that a prescription drug be made available over the counter. This is often done at a reduced dose, which seems a bit silly to me: OTC motrin is 200 mg, while prescription motrin is 400, 600, or 800 mg. There is nothing to stop someone form taking 4 200 mg tablets and getting the "prescription" 800 mg dose.

If I am not mistaken, several drugs like Zantac have become available over the counter just after they come off patent. I suspect the manufactureres choose to make up in volume what they lose when their monopoly ends.

Several antihistamines did become available OTC recently. The manufacturers don't benefit from advertising the newly available generics, so they invent new patents by mixing their antihistamines with decongestants; but many of these are also available OTC.

 

[gdnp]

My guess is it has something to do with the law, and not some magical property of the license. Are you seriously suggesting that people are incompetent to solve problems if they don't have licenses? If so, that's a false dilemma.

No, I am suggesting that it is worthwhile to have a system where people who perform dangerous jobs have demonstrated proficiency in that job. The license is not magical, and does not guarantee that you will not make a mistake, but it does demonstrate that you have mastered necessary skills so as not to be a hazard to yourself and your community.

I don't know what the laws are where you live, but when a contractor builds a house doesn't the wiring and plumbing need to be supervised by licensed electricians and plumbers? If you wish to rewire or replumb your house, don't you need a building permit? Doesn't the building inspector need to sign off on it?

I know people who do their own plumbing, rewire their own homes and so on. More importantly, I'm not familiar with any laws which require them to get permission from a plumber or an electrician to buy plumbing supplies.

Some of this is probably the equivalent of over the counter drugs: simple, relatively safe things that prudent amateurs can handle themselves. The rest is illegal and potentially dangerous. Fires are caused by faulty wiring all the time.

Last time I checked, you didn't have to get permission from a pilot to buy a plane.

Now it is your analogy that is faulty. You may not need persmission to buy a plane, but you sure need permission from the FAA to fly a plane. Do you want to buy drugs or take them?

 

[The Atheist]

Really? I didn't know that. I guess electricians licenses are optional. I wonder why electricians bother getting them

USA probably has state-by-state rules for electrical wiring, but given the propensity for people suing each other in USA, I imagine that wiring without a licence is asking for trouble at a minimum.

Here, it is illegal to carry out any project bigger than changing a light bulb.

Do your own plumbing, painting and tiling, but leave the electricity to a sparky.

 

[Richard Masters]

No, I am suggesting that it is worthwhile to have a system where people who perform dangerous jobs have demonstrated proficiency in that job.

People who want licenses to drive don't need to learn to operate other types of heavy machinery like tanks and airplanes. They aren't required to be engineers.

The license is not magical, and does not guarantee that you will not make a mistake, but it does demonstrate that you have mastered necessary skills so as not to be a hazard to yourself and your community.

I'm not trying to provide a service to others. Only to myself in limited circumstances. They don't offer adequate licenses for that. I shouldn't need to study gynecology, geriatrics, anesthesiology, etc... and become an intern to purchase an unrelated medication that I understand chemically and has helped in the past.

I don't know what the laws are where you live, but when a contractor builds a house doesn't the wiring and plumbing need to be supervised by licensed electricians and plumbers? If you wish to rewire or replumb your house, don't you need a building permit? Doesn't the building inspector need to sign off on it?

I wouldn't know because it doesn't affect me for practical purposes. I don't check the law every time I need to unclog a toilet, or build a new computer.

Some of this is probably the equivalent of over the counter drugs: simple, relatively safe things that prudent amateurs can handle themselves.
The rest is illegal and potentially dangerous. Fires are caused by faulty wiring all the time.

Prudent amateurs in electronics have access to hardware stores. There are no practical obstacles if you know what you are doing. The same is not the case with pharmacology, where even if you know what you are doing, you do not have access to necessary tools.

Now it is your analogy that is faulty. You may not need persmission to buy a plane, but you sure need permission from the FAA to fly a plane. Do you want to buy drugs or take them?

We are still on your analogy, remember?

 

[fls]

From what I can glean from the non-answers to my questions (), the OP is talking about self-diagnosis and treatment of mood disorders. Taking this into consideration, what is being asked for is what already happens - just too slow, in this particular case, to solve his current problem. When medications are made OTC, what is taken into consideration are just the sorts of questions that I asked earlier - what condition does the drug treat? how amenable is it to self-diagnosis and self-monitoring? is it relatively easy to use the drug safely? If the answers to those questions are reasonable, as Richard demonstrates they may be, then those drugs will be moved to OTC status.

I doesn't seem out of the realm of possibility that some anti-depressants may be made over-the-counter. What hasn't been shown here, is that considering the issue on a case-by-case basis should be abandoned in favour of making all drugs OTC.

Linda

 

[Richard Masters]

From what I can glean from the non-answers to my questions (), the OP is talking about self-diagnosis and treatment of mood disorders. Taking this into consideration, what is being asked for is what already happens - just too slow, in this particular case, to solve his current problem. When medications are made OTC, what is taken into consideration are just the sorts of questions that I asked earlier - what condition does the drug treat? how amenable is it to self-diagnosis and self-monitoring? is it relatively easy to use the drug safely? If the answers to those questions are reasonable, as Richard demonstrates they may be, then those drugs will be moved to OTC status.

Maybe 50 years from now. But I wasn't really asking the FDA to make it an OTC drug; I was asking for the FDA to recognize we are not all idiots who are going to drink hydrogen peroxide after every meal, just because it is available without a prescription.

Here's a better solution, why don't we incarcerate people who are dumb enough to drink hydrogen peroxide, so that the rest of us can make informed decisions about our own health without having to worry about unnecessary overdoses.

If that doesn't seem fair to hydrogen peroxide drinkers, that's probably because it isn't; and still, it's a better solution.

I doesn't seem out of the realm of possibility that some anti-depressants may be made over-the-counter. What hasn't been shown here, is that considering the issue on a case-by-case basis should be abandoned in favour of making all drugs OTC.

I don't think anybody is asking for that, though.

Linda

 

[drkitten]

But I wasn't really asking the FDA to make it an OTC drug; I was asking for the FDA to recognize we are not all idiots.

The problem, though, is that --- as I cited earlier --- the people who are idiots are the ones who are the most convinced that they're not.

How do you expect the FDA to recognize the true non-idiots from the false ones?

Offer a test? By astonishing coincidence, that's what they already do. You take your MD classes, sit your boards, and are licensed to practice medicine.