Medical Doctors / General Practitioners

[WildCat]

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?

You can, there are no restrictions as to who can buy wire, breakers, etc.

 

[WildCat]

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.

Particularly with skilled trades, there's another reason that permits can only be pulled by licensed individuals - it's a way for politicians to throw a bone to the unions dominating such trades.

Chicago, for example, requires a licensed plumber to install a new faucet on a bathroom sink. This is a project pretty much anyone could do themselves.

 

[gdnp]

So what are we arguing about here? We all seem to agree that there are some drugs that are safe enough that they should be available over the counter. There are other drugs that are dangerous enough that they should only be available via a doctor's prescription. There are probably quite a few drugs that are prescription only that are safe enough to take without one. Is there a specific drug that you think is overregulated?

BTW, I recall reading that some of the "Canadian" Internet pharmacies would sell prescription drugs to Americans without a prescription: you fill out an on line form that is reviewed by a "doctor" who then determines whether you get the drug. I obviously cannot vouch for the quality of the "physician" who makes this determination, or the authenticity of the drugs you receive, but you get what you pay for.

 

[Richard Masters]

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.

That's overkill and even more costly.

Yes, offering a test (a relevant test) would be an adequate and responsible solution.

 

[WildCat]

As far as medical prescriptions go, a good example is contact lenses. You can save a lot of money by ordering them through the mail, but a prescription is required. My prescription has been the same for 15+ years, but the requirement for a prescription (and the eye exam required to get it) adds much cost. For someone like me who's been wearing contacts for over 30 years I'll know when my lenses are no longer doing the job, all the doctor's exam does is raise my costs.

 

[drkitten]

That's overkill and even more costly.

Yes, offering a test (a relevant test) would be an adequate and responsible solution.

Hmmm. Let me see. The FDA list of approved drugs is approximately 400 pages long, with between 50-80 drugs per page. Since you are unwilling to take a general pharmacology course, the FDA would have to be able to give and deny permission on a per-drug basis, which in turn means that the FDA would need to offer tests for individual drugs.

That means the FDA would need to develop and administer 32,000 different tests.

And you think this is the less costly and responsible solution?

I'm sorry. You just convinced me that the adequate and responsible solution is for the FDA to tell you and similarly situated people to suck it up and deal.

 

[Richard Masters]

As far as medical prescriptions go, a good example is contact lenses. You can save a lot of money by ordering them through the mail, but a prescription is required. My prescription has been the same for 15+ years, but the requirement for a prescription (and the eye exam required to get it) adds much cost. For someone like me who's been wearing contacts for over 30 years I'll know when my lenses are no longer doing the job, all the doctor's exam does is raise my costs.

That's a perfect example. I have nothing to add.

 

[Richard Masters]

Hmmm. Let me see. The FDA list of approved drugs is approximately 400 pages long, with between 50-80 drugs per page. Since you are unwilling to take a general pharmacology course, the FDA would have to be able to give and deny permission on a per-drug basis, which in turn means that the FDA would need to offer tests for individual drugs.

I'm willing to take a pharmacology course. I'm not willing to pay for a full M.D.

It's ridiculous to think that the FDA would have to offer one test per medication. There are several classes of medications, and you wouldn't have to resort to testing each class either, if you can ask practical questions about how they are metabolized, or about the actions of major neurotransmitters.

Additionally, since it's safety you are concerned about, the questions can be relegated to that context. For example, "Why should MAOIs be avoided"?

Or, "What's the difference between MAO-A and MAO-B?"

A couple of questions can cover adverse interactions and safety for most anti-depressants.

Next,

What makes aspirin so different from other NSAIDS like ibuprofen as it relates to Cyclooxygenase?

(I'll bet you most people don't know that one, and yet aspirin is OTC).

List 5 drugs with a narrow therapeutic range, and 5 safer alternatives.

What is the general effect of acetylcholine on the peripheral nervous system?

What are mast cells?

Based on the following 3 drug profiles and 3 patient histories explain which of the following patients is most likely to have an adverse reaction to treatment and explain why.

...etc.

That means the FDA would need to develop and administer 32,000 different tests.

And you think this is the less costly and responsible solution?

Not at all, but I did offer a better solution.

You don't need to prove that a patient understands the chemical structure of each molecule, or have them memorize a drug profile. You simply need to prove that they are resourceful enough to figure out what is safe and what isn't, and that they can explain why.

The intention here is to keep people safe, not to make sure they can synthesize the drug.

I'm sorry. You just convinced me that the adequate and responsible solution is for the FDA to tell you and similarly situated people to suck it up and deal.

You just convinced me you want human beings to be dependent on their doctors. Do you think informed and resourceful individuals make doctors less valuable? I do.

 

[drkitten]

You just convinced me you want human beings to be dependent on their doctors. Do you think informed and resourceful individuals make doctors less valuable?

Not at all. But you've convinced me that the people who think they're "informed and resourceful" are the ones least likely to be so.

 

[fls]

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.

Then I'm really confused. You said that you wanted to be able to purchase drugs without requiring a prescription from a physician. How would that happen? You want a special exclusion for specific individuals (which would manage to include you, of course)?

Linda

 

[calebprime]

We've had the example of anti-depressants and I think you could make the case that they are underutilized anyway...
Linda

I think you can make the case that ADs are over and under-used.

They are powerful drugs that should be treated with as much caution as anything else.

I know this because at one time I went to the doctor, thinking I was depressed. It was very easy to convince them that I was. They prescribed Prozac--the usual hit or miss technique.

It made me hypomanic in ten days as well as completely impotent--I couldn't sit still and my thoughts derailed--I could barely finish a sentence.

It felt exactly like being high on cocaine--a feeling I despise--plus being cut off from all erotic feeling.

I discontinued it--so called non-compliance.

I almost immediately felt much better--although the life situation that was stressing me out remained. That gradually improved, over the years.

This "non-compliance" was one of the better decisions I've ever made--I certainly would have gone bonkers if I continued to feel that way.

This experience, plus reading Breggin, Glenmullen, Alice Flaherty, William Appleton, and everything else I could get my hands on, convinced me that these are not drugs that people should self-prescribe, nor are they drugs that necessarily improve mood or make people feel better.

I do not think that the world would be a better place if more people were on SSRI's, but I admit I can't do the math--that's just my hunch based on my own (high strung) brain chemistry.

 

[fls]

I think you can make the case that ADs are over and under-used.

They are powerful drugs that should be treated with as much caution as anything else.

I'm not going to argue with you on that.

Linda

 

[Neally]

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?

Two separate situations. One, you are working on your own property. If you botch the work, it's your own problem to deal with. Likewise if I buy a medicine, even if OTC, and misuse it, I pay the price.

Completely differently, I shouldn't be prescribing medicine to others without training, nor should someone be able to perform potentially dangerous repairs on other peoples homes without training.

You can't save everyone from doing stupid things to themselves. The arguments that only physicians should allow people to get certain drugs takes away individual responsibility and unnecessarily increases the costs. If prescribed drugs were readily available OTC, people could still go to a nurse, or physician for advice. Others could make their own decisions and deal with the results.

 

[fls]

Two separate situations. One, you are working on your own property. If you botch the work, it's your own problem to deal with. Likewise if I buy a medicine, even if OTC, and misuse it, I pay the price.

Yeah? You promise nobody would try to sue the manufacturer?

Linda

 

[Neally]

Yeah? You promise nobody would try to sue the manufacturer?

Of course not, just as anyone can sue anyone else for anything they want with the current system. If the drug manufacture gave full and complete disclosures, they shouldn't be held responsible for misuse of their products, whether OTC or prescription.

 

[Richard Masters]

Then I'm really confused. You said that you wanted to be able to purchase drugs without requiring a prescription from a physician. How would that happen? You want a special exclusion for specific individuals (which would manage to include you, of course)?

Linda

See my response to DrKitten. Yes, I want an exclusion for specific individuals.

 

[Richard Masters]

Not at all. But you've convinced me that the people who think they're "informed and resourceful" are the ones least likely to be so.

Oh yeah? Well you just convinced me that ...

OK, regarding your last response, how so?

 

[Richard Masters]

Yeah? You promise nobody would try to sue the manufacturer?

Linda

Great idea, I'll just sue all my doctors. Then I can afford them.

ETA: Better yet, I'll drink hydrogen peroxide and sue the manufacturers + the FDA for making H2O2 available to me without a prescription.

Then, I'll eat some play-dough hamburgers for breakfast and go after Mattel, for the same reason.

 

[gdnp]

Completely differently, I shouldn't be prescribing medicine to others without training, nor should someone be able to perform potentially dangerous repairs on other peoples homes without training.

So parents shouldn't be buying medicine for there kids. Of course, there is nothing to stop that.

You can't save everyone from doing stupid things to themselves.

Which doesn't mean that you shouldn't attempt to stop people from doing stupid things to themselves when you can. Otherwise you end up paying for their kidney dialysis or taking care of their kids.

The arguments that only physicians should allow people to get certain drugs takes away individual responsibility and unnecessarily increases the costs.

It limits personal responsibility and necessarily increases costs.

If prescribed drugs were readily available OTC, people could still go to a nurse, or physician for advice. Others could make their own decisions and deal with the results.

If that were the case then you might have an argument. Unfortunately, society does not work that way. The motorcycle rider who refuses to wear a helmet and the car passenger who refuse to wear seatbelts sustain injuries that we all have to pay for. If you put yourself in a coma through self-prescribing drugs incorrectly are we going to turn off your respirator once you have exhausted your family's resources? Who's going to pay for your now-destitute children's education?

 

[Richard Masters]

It limits personal responsibility and necessarily increases costs.

If that were the case then you might have an argument. Unfortunately, society does not work that way. The motorcycle rider who refuses to wear a helmet and the car passenger who refuse to wear seatbelts sustain injuries that we all have to pay for.

Great, let's ban cars. After all, some people will never wear helmets or learn to use seatbelts.

If you put yourself in a coma through self-prescribing drugs incorrectly are we going to turn off your respirator once you have exhausted your family's resources? Who's going to pay for your now-destitute children's education?

Same thing applies with driving and incorrect turn signals, or wearing the wrong seatbelt; or wearing the right seatbelt the wrong way; or driving on the wrong side of the road.