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View Full Version : all prescription drug laws should be abolished


fossildoc
11-30-2007, 11:44 PM
The subject doesn't refer to recreational drugs, but rather to prescription drugs used for medicinal purposes.

Everybody knows that the "good stuff" is protected by prescription laws. If you want to self-medicate for TB, sorry, the multi-drug regimen requires a trip to the doctor for a hefty hundred bucks or so, then a trip to the pharmacist, who gets about a fifty percent markup on everything.

Do we need this?

Yes, I know, people shouldn't be allowed to take drugs which will eventually harm them, like making them deaf from too much tetracycline, or dying from cardiac insufficiency with an overdose of a hypertensive.

(I wonder why acetominophen does not require a prescription, since overdose causes liver failure.)

I agree with every argument that supports prescription laws based on protection of the patient. We're all going into medicine to help people, not watch them self-destruct.

But every argument has at least two sides -- that's why it's called an argument. The other side of the prescription argument is civil rights, not to mention the huge savings to be realized by doing away with those pesky pharmacists who have long outlived their usefulness from the days when prescription medicines had to be titrated, or ground with a mortar and pestle, in the pharmacy.

Simply put, people should have the right to do anything that doesn't harm others, and they should not have to be "educated" by the enlightened rest of us. This right, IMHO, supercedes protection from oneself.

Yes, I know, harming oneself may inadvertently do harm to others, like when an overdosed person crashes a car into innocent bystanders. The counter to all such arguments is easy: alcohol and tobacco, the latter of which is subsidized by the U.S. government. As long as alcohol and tobacco are freely available to the public, any pro-prescription arguments based on controlling dangerous substances for the public good are as hypocritical and vacuous as requiring med students, but not teachers, to wear a school uniform for the purpose of <your lame excuse here>.

What about wanton recklessness that causes damages to others while under the influence of self-medication? Easy. We charge people will crimes committed while they are drunk or under the influence of recreational drugs. The same should apply to all drugs, with certain exceptions that are already covered by applicable laws (unanticipated heart attack from prescription drug while driving, etc.).

That leaves the question of whether average citizens are qualified to self-medicate. No, they are not, but so what? The idea of civil rights is not that we can exercise rights provided the government first tests our ability to do so responsibly, but rather that those rights can be exercised in spite of what the government may want. In the area of civil rights, the default case is always in favor of the citizen, not the government. People can do whatever they want unless prohibited by law, rather than being allowed to do only what is expressly permitted.

In Belize, where I spent my first two semesters of medical school, every prescription drug sold in the United States, with the exception of controlled narcotics, was available over the counter at the local pharmacy. Physicians do write prescriptions, but they are merely notes to the pharmacist, who returns the prescription to the patient. I got my topical corticosteroid medications that way, and refills without any prescription. I paid about a quarter of what those drugs cost in the states, and they weren't made in China, either; they are the same drugs made by the same U.S. manufacturers as what I would get in Miami. Complete with expiration date in a factory-sealed box. They work just fine.

My argument distills down to whether it is a legitimate function of government to protect its citizens from self-imposed harm based on ignorance or carelessness. I say no, it is not, but if you think it is, then you must allow the intrusion of government into every aspect of our lives, requiring a license for every potentially dangerous thing we do, from using a steak knife to slice up a T-bone to riding a bicycle.

I say we should abolish all prescription drug laws in the United States. People who self-medicate are fools, of course, just like lawyers who self-defend, but we should not exact a tribute from people to obtain the blessing of an "expert" before paying drug prices which are already inflated by the time they get to the pharmacy.

What do you think?

teratos
12-01-2007, 08:39 AM
I think you would have a lot of people die if all medications were over the counter. All you have to do is review the messages I get in a week. Some examples:

"I need triamcinolone refilled, I have a rash"
I bring them in, they have a raging cellulitis and a fever. This happened to me on tuesday

"I need prednisone, my asthma is acting up"
My partner brings them in, they are having shortness of breath on exertion with some chest tightness. No wheezing or coughing. The cardiac cath later that afternoon shows severe 3-vessel coronary disease. Went for bypass later that afternoon. This was thursday.

"Pt. needs lasix. Right leg swollen, a little short of breath"
This was last friday. A retired nurse. I recommended she go to the ER. Thought she had a DVT and PE, she thought she'd just come in for a visit because she didn't want to sit in the waiting room. :rolleyes:. Pulse 130's, PulseOx 85% on room air. Sent to the ER, this time via ambo from my office. Guess what? DVT/PE

Just and example of 3 people in the past week who would have treated themselves, and would have potentially died.

TO go further into potential problems that may arise from this that will impact you as a doc directly. We live in such a litigious society, that had these 3 people died, "Someone" would have to pay, right? Since it was a medical problem that killed them, who do they talk to first? If you guessed their doctor, you guessed correctly. Now the cellulitis and the DVT/PE, you could easily argue aren't malpractice. These can develop quickly, and if you haven't seen this patient for a while, noone can blame you. Of course, it won't stop the lawyers for naming you in a lawsuit and deposing you etc. Taking up your time, causing you stress. Now, the lady with the coronary disease is a different story. They will get "expert" witnesses to review your chart, determine that you never asked the appropriate questions, didn't further investigate some vague complaint 2 years ago (they had pleuritic chest pain with a bronchitis, that resolved after antibiotics), and you are now responsible for this patients death.

Just a happy thought for the day.....:D

fossildoc
12-01-2007, 10:33 AM
I agree with everything you say.

I've already conceded that people who self-medicate are fools. My point is, however, that in the balance between civil rights and good medicine, civil rights should supercede. We should have the right to self-destruct. I don't want government telling me I should go to a surgeon instead of attempting do-it-yourself appendectomy. I do, of course, chose the surgeon, but I would not impose that on others.

The lawyer thing is a detail. I opt for the Shakespeare solution.

teratos
12-01-2007, 10:52 AM
If you could fix the malpractice thing, i would be fine with people killing themselves. G

AUCMD2006
12-01-2007, 11:05 AM
I agree with everything you say.

I've already conceded that people who self-medicate are fools. My point is, however, that in the balance between civil rights and good medicine, civil rights should supercede. We should have the right to self-destruct. I don't want government telling me I should go to a surgeon instead of attempting do-it-yourself appendectomy. I do, of course, chose the surgeon, but I would not impose that on others.

The lawyer thing is a detail. I opt for the Shakespeare solution.

wait til you meet more average patients, i am begining to think that we should have reproduction laws. on avg people have no idea what is going on with thier health and a google search is good for some things but reading a few webmd pages does not render a patient able to self treat...heck some medical conditions are so tough even MD's have ahard tome dx them

if you follow this train of thought then why regulate anything..i want to build myself a building why restrict me to actually having a strcutural engineer and architect design and approve plans....i have google i had high school math why does "the man" feel the need to regulate me. why regulate the food industry? we can go on and on about these scenaries but bottom line is all these things that are regulated are done so to protect the majority of people that is why we vaccinate, regulate food, and have the fda epa, etc. does it work? somewhat yes and sometimes no

fossildoc
12-01-2007, 11:25 AM
Don't think reproduction laws haven't been considered; mercifully, not in the U.S.

I don't advocate deregulating anything -- for the moment -- except for the drug prescription laws. The distinction between self-medication and strucutrual engineering, blood, and food lies in who stands to be harmed. When the actions of an individual may harm others, like donating contaminated blood, it is a legitimate role of government to regulate the process, IMO. When consequences afflict only the actor, regulation should not apply. There are overlaps and details which I mentioned in the OP, but they will exist no matter what type of regulatory environment you concoct. If you want to regulate everything that is potentially harmful, then you must be willing to hire a licensed steak knife operator if you wish to partake of that T-bone, and all children must obtain a bicycle operator's permit. Remember, too, that anything government regulates will be taxed.

Speaking of the fda, are they anything more than a revolving door for big pharma executives? Isn't it strange that they rely on data from the very companies whose applications they are judging? And if you think the epa is worth what it's costing the taxpayers, turn on the tv any night to hear the latest scandal about food or toy contamination.

The concept of the fda and epa are fine; they are examples of what government should be doing. Implementation is another story; they are both useless, IMO, and need to be rebuilt with executives who have no ties whatever to the industries they regulate.

AUCMD2006
12-01-2007, 01:26 PM
that is the point, deregulating prescription laws will harm more than the self. deregulate antibiotics and you will have more resistant organisms because everyone wants to take abx for any sniffle or ear twinge. that is just the tip of the iceberg you are making yourt own point overegulating doesn;t work, as in your licensed steak knife scenario, but deregulating medicatioons will harm far more people than just the individual schmuck who self treats

as for the fda and epa i said its not working well but to contrast a place without those bodies all you gotta do is take a trip to any eastern block country and see industry there...care to drink tap water from any country there?

fossildoc
12-01-2007, 01:52 PM
...deregulate antibiotics and you will have more resistant organisms because everyone wants to take abx for any sniffle or ear twinge... all you gotta do is take a trip to any eastern block country and see industry there...care to drink tap water from any country there?
Let's license sex. Deregulated, we have more organisms than we want because everybody wants to do it.

You're right in your approach; we must weigh the cost and benefits for both the regulated and unregulated scenarios, and choose the one that most benefits society.

Or should we? Don't civil rights come at a cost? The right to bear arms has a cost, but we allow it because the Founders wanted to empower the citizenry to overthrow the government if it became too oppressive. Anyone who believes it was to enable hunters to shoot quail is woefully ill-informed about constitutional history. In other words, the cost of bearing arms is outweighed by the greater principle of resisting government, which doesn't generally make problems better.

The cost of deregulating drugs may be that we have a lot of drug-resistant citizens, but isn't that better than allowing bureaucrats to determine what substances we ingest in an attempt to heal ourselves?

If my car was broken I wouldn't have the chutzpah to try to fix it myself; I'd go to an expert mechanic whom I trusted, for whatever reason. If s/he tells me I need a set of spark plugs, then so be it. But if I'm foolish enough to risk destroying my car by doing the job myself, that should be my business; I shouldn't be required to get a prescription from a mechanic to buy a set of spark plugs.

The underlying principle behind my opinion of prescription laws is that government is a Bad Thing and is never to be trusted beyond doing their three basic functions: common defense, infrastructure, and a social safety net. I would change my mind if I were convinced that harm to many innocent people would ensue from deregulating drugs, but I look at Belize, whose public health structure I had to study as part of a school assignment, and I see no obsession with self-medication, but rather a welcome relief of desperately poor people from the predations of greedy drug companies.

BTW, not even the locals drink the tap water in Belize.

Who do you think are big time contributors to federal campaigns? Pharms, alcohol, and tobacco, that's who. Do you think tort reform will ever come from legislatures that are dominated by lawyers who must return to (mostly) civil practice when they get voted out?

On balance, weighing the costs and benefits of a prescription-free world, I say get of the retail pharmacists and vote all the lawyers out of legislatures. Put ordinary folk in their place and put a lid on malpractice suits, so that the poor can afford the medical care of the rich.