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Wednesday, October 10th 2007

Do You Need A Doc For All Drugs?

A proposal to create a new class of drugs, to relabel the risk aversion this country has with medicines, is before the Food & Drug Administration. Call them “semi-over the counter” drugs.

[T]he Food and Drug Administration is considering creating a different option, a class of medicines dubbed behind-the-counter drugs. It would let consumers purchase routine medicines that could include birth control pills, cholesterol drugs and migraine medicine without a prescription — as long as they discuss it with a pharmacist first.

I’m more than comfortable with this. The response I imagine from most physicians is…well, as you would imagine.

Dr. Anmol Mahal, a Fremont gastroenterologist and president of the California Medical Assn., said the federal agency’s proposal was ill-conceived and unsafe for consumers.

“Patients are not clinicians,” he said. “Allowing people to self-diagnose and self-treat is not in their best interest. Nothing could be farther from the truth.”

Meaningless words from the CMA that miss the real debate. The debate always is and always will be how much risk is acceptable. True there’s some evidence that the populace doesn’t swallow risks associated with medications real well. They don’t understand them and they’re not willing to accept them it sometimes seems like.

That’s merely a matter of education and process, not a hard core limitation to access. I think the behind the counter class is a good idea that has worked well in other parts of the world.

My Dream: You Can Buy A Statin In A Gas Station Men’s Room

Beyond convenience, the plan also has the benefit of likely reducing costs.

Much will depend on which behind-the-counter drugs insurers decide to cover. Most insurance plans today cover prescription drugs but not over-the-counter drugs. Insurers say they are researching the FDA’s proposal.

“Increasing patient control and access to medication while dramatically lowering cost to the consumer is a laudable goal,” said Nicole Kasabian Evans, a spokeswoman for the California Assn. of Health Plans. “We would like to work with the FDA to learn more about their efforts.”

Even then, think about the reduction in physician office visits. In my family medicine rotation right now there are just a ridiculous number of patients who present merely for medication refills. Granted these are patients with multiple medical problems, who have had their dosages and specific meds tinkered with to date. Granted, many patients (indeed the ones most likely to benefit from the behind the counter meds) can merely call in for refills but from my experiences the past month behind the counter meds could still contribute to a reduction in office visits.

Think about the reduction in drug costs as consumption likely goes up. And for an ‘acceptable’ risk.