Should we need a prescription for drugs, and why?

[The Straight Story]

Sounds simple, and trivial - but it harbors deeper things IMHO.

Our government controls what we can and cannot have over the counter, perhaps because they (as well as others) see the avg person is 'evil' at the core - IE, the avg human would misuse drugs.

We have restrictions and laws on such things because we as a group of people cannot be trusted en masse to 'do the right thing' so we elect a few who can lead us and tell us, force us with threat of jail, to do things 'right' (for both ourselves and others).

Now as to why I thought about this: Was thinking about how I would stock up in the case of world-wide (or local) major catastrophe, and medicine is something which could dry up quick. I can buy food in bulk, power through guardian systems and such, over the counter meds, water, and so on. But if I wanted to stock up on anti-biotitcs and such I would hit a brick wall (outside of herbal remedies and other such things). I could understand it, but it did make me ponder the whole thing.

It came down to 'trust' I guess. The government limits us because (perhaps) the masses are not to be trusted, only the few. Now this could be extended to the extreme, nuclear and bio weapons for home use for example, but those seem to have a broader application which could affect more than just yourself.

So at any rate, your thoughts in general on all this and some of the ideas behind the deeper idea and how this may well play into religion and limiting people because they cannot do so themselves (and not a slam on religion, christian myself, one could insert philosophy or political ideology in place of religion - I mentioned it though due to the discussions of late on the religious right here and * and thought it appropriate).

Perhaps a summarized ideal - how much power should the few have to regulate the many, and do we view the many as 'less capable' than the few and so we allow them to dictate to the many what they can and cannot have (and again, without going to too far extremes of the obvious).

Thanks for the input and thoughts, just pondering this all.

[American Tragedy]

1. It's because they can charge far more for prescription drugs than OTC

end of story.

[Heddi]

5. Not necessarily 'end of story'

there are many many medications that can cause quick death if someone were to take them who didn't have a medical condition that required the medicine.

Heart medications, blood pressure medications, cancer medications, etc---these all save lives when taken correctly...but if someone taking Blood Pressure Med X takes Heart Medication Y while on THyroid Medication Z (which are all allowed to be taken together) suddenly gets ahold of Gastric Medication M---they could DIE.

If someone takes a heart medication and doesn't have a heart condition, they could DIE.

Are medications overpriced? Absolutely. I'm very much in favour of low drug prices but I think that the majority of drugs that are Rx controlled should continue to be controlled by Rx so that patients aren't taking drugs that are contraindicated and end up with life-threatning diseases or worse because 1) they don't read the labels (too common), 2) they don't have the werewithall to read a big PDA or Drug Handbook to see contraindicated drugs, etc.

Also, many drugs have very short "therapeutic ranges" which means that the level needed to produce pharmacologic benefits in the body is very very close the the level needed to OD the patient. A popular heart medication, Digoxin, is such a drug. Patients on that drug have to take their BP before taking the drug and have to have serum digoxin levels drawn (a blood test) regularly to make sure they've not reached toxic range.

Also, many drug doseasges vary depending on the disease or disease process being treated. 0.25mg of this drug may control your high blood pressure, but 1 mg may treat your heart attack, but cause other problems if you don't have a heart-attack but are taking the 1mg dose.

Believe it or not (and I know it's hard to believe) but not EVERYTHING health care related is done on the basis of profit or control. Sometimes---sometimes---things are done for patient safety.

[Nikia]

2. Yes for a couple of reasons

1.It is a public health issue when large numbers of people misuse antibiotics as bacteria can develop immunity to them. Allowing only people who need them to use antibiotics, slows this evolution down.
2.Some drugs are dangerous to people with certain health conditions or who take other medicines. Having a doctor prescribe drugs can minimize patients taking drugs that are harmful to them.
3.Come people may misdiagnose their problems. It is better to have a medical exam first before assuming that one has certain conditions. This is especially true in the era of rising health care costs.
4.Drug testing is common in many workplaces. Some companies will fire employees with certain drugs in their system unless they have a prescription.

[Djinn]

3. absolutely

how many people do you know that tell you they have "the flu" when they have a cold or that tell you they have a "migraine" when they have a headache.

Hypocondriacs would LOVE to just tell the pharmacist to hand over strong drugs they don't need but I really don't see a public good in it.

[The Straight Story]

7. So it is the 'people' in general that are the problem?

My only problem with this is, where does it end? I understand the reasons, I just have some problems with painting 'the people' as incapable of making intelligent decisions so we make it for them.

Just don't always like where it leads... :)

[Djinn]

15. no it's people without the knowledge

I consider myself perfectly able to make informed decisions about my own welfare but I can only do that if I am INFORMED.

If a GP suggests I take something I can ignore him, I can go to another GP but without his input how on earth do I know what the best treatment for XYZ??

The government also prevents me from building skyscrapers or flying a plane and for the same reason - public safety

[murray hill farm]

4. i live in Mexico where most drugs can be bought

without any prescription...and, if a way that is a good thing, but i still think it is better to have a prescription for a lot of reasons..but mainly to determine things like appropriate dosage and length and frequency of doses. It is so easy to overuse antibiotics..and increase bacterial resistance to the drugs by this overuse..and then there is the problem of medications reacting adversly with other medications..and then there are side effects of medicationsl, etc. At present, we pay doctors to be the ones to know these things and prescrive drugs..and people really will not take the time to keep up on medications, etc...it would be then just too easy to get the flu...and just go buy an antibiotic...or feel depressed or anxious...go buy some xanax or whatever...too easy...and then you get hurt because you dont know all the effects and dangers of these medicines.

[girl gone mad]

17. Doctors consistently overprescribe abtibiotics,

so I'm not sure that requiring a prescription has been much of a barrier to overuse.

Other than that, I agree with you.

[blondeatlast]

6. Yes for the reasons supplied above, and also to prevent the callous

misuse of Rxs for purposes they weren't intended.

I'm an insulin-dependent diabetic, and a friend once STOLE a bottle of insulin and injected it because she heard it would make her lose weight. That wa the one bottle my insurance paid for for the month. It was only after she'd realized it didn't work that she told me.

Mind, this was very shortly after the Sunny von Bulow murder (yes, I believe it was).

[The Straight Story]

8. A friend of mine died using someone else's prescription

He was at his house for thanksgiving, and his ankle pain flared up real bad. He took his friend's morphine, too much, and died. He was 27, and one heckuva nice guy.

[Johonny]

9. Good posts so far.

I'm fine with the reasons we have presciption drugs. Also pointing out some prescription drugs are highly addictive and the prescription is suppose to help monitor your ussage to make sure you don't end up like Rush.

The question is since we have in general a fine prescription drug laws why do we also have to have these special drugs that are also highly illegal. The war on drugs is the real villian not prescriptions.

[The Straight Story]

10. To me it (perhaps) comes down to control

Of many things. Where does control end, and what are the reasons it is exterted by the few on the many (as it were). We trust some people (the educated and politicians) to make choices and limit choices for us (and that, to me, is the root of the question).

So we have a mass of people, us citizens, who cannot be trusted to make the right choices and we cede that control to others instead. Where does that end I suppose is the deeper question (and how does it relate to us as individuals versus us as a society)?

[Johonny]

12. It's not so much trust as

the fact you can't possibly know everything. I mean there are certain things important enough to seek a consultant before doing.

[amazona]

11. no use stocking up on antibiotics anyway

If it makes you feel any better, antibiotics are highly perishable so it does no good to stock up on them. They spoil. In event of apocalypse, you probably won't have refrigeration for long-term storage of your antibiotics so they wouldn't be any good for long anyway.

The conservation movement is a breeding ground of communists
and other subversives. We intend to clean them out,
even if it means rounding up every birdwatcher in the country.
--John Mitchell, US Attorney General 1969-72

[The Straight Story]

13. indeed

but the bigger question dealt with who makes the rules, the few over the many and why. But yeah, I don't think I would stock up too much on them - that though led to this thread.

Thanks for the post!

[vpigrad]

14. It's to protect the profits of the medical cartel!

That's the only reason. They're the ones keeping us from the drugs we need. I know most people can't afford the healthcare they need because of the medical cartel, and needing their blessing in order to buy the drugs they need just adds insult to injury.

[Djinn]

16. not quite

those cartels only prevent the poor accessnig medicines if your government allows that.

we have a publicly funded prescription drug system which may be sold out by our current lot to impress George and friends but as of now a pensioner needing arthritis drugs can afford them, students needing contraception can afford them etc etc

[vpigrad]

19. You're repeating the repuke lies!

> a pensioner needing arthritis drugs can afford them,

Do you really buy that lie? I don't know anyone that can afford the drugs they need. Period. There is no arguing around the fact that the medical cartel has priced drugs out of the reach of the working class.

[Djinn]

24. try READING the post

I don't live in the US I live in Australia (that whole bit about having a publicly funded prescription drug scheme should probably have given you a hint)and the cartels can price a drug stupidly high if they like, all that will mean is that they'll see a generic drug be added to the PBS and they'll get diddly squat.

You really should be sure of yourself begfore accusing someone of repeating repuke lies - I'd bet that I'm WAAAAY to the left of yourself - left wing Americans tend to look pretty conservative to Australians/Europeans, and frankly it pisses people off to be called freeps/republicans/kool-aid drinkers

[ynksnewyork2]

18. Yeah, I think so

Too dangerous without them.

[The Straight Story]

20. understand that - question is

Who decides it is dangerous, why, and does this create a 'class' (if you will) that knows more than the rest of the masses and should use that to restrict our freedoms? And what does all this lead to? A group of people at the head who know better than we and therefore tell us how to live and what we can do and have access to?

Now we have * as the leader of that small group who tells us what is best for us - and I don't think I am ready to cede to him and the current leaders that they know what is best for us - but in a government where we readily agree to do so, this is a problem. Perhaps the question is - how much are we willing to cede to others due to our lack of knowledge; like, for example, legislation where the law makers are supposed to 'know more' and what is best because they are in the know on these things and we are not - although they might maintain that special interests are, etc and so on.

The core reasons are what I am wanting to glean - and how those reasons can expand out into other things.

[Heddi]

22. The "class" that knows more than the 'rest'

are people like me, who are in Nursing School, or people who are in pharmacy school, or medical school.

There's nothing special about me. I'm not in some Skull-n-Bones club that allowed me to get into Nursing School. I took some prerequisites, filled out an application and waited to be accepted to the program.

Why is anything regulated? Why can only trained surgeons perform heart surgery? I mean, someone could look at Gross' Anatomy and feasably do open heart surgery, right? Is "the man" keeping "us down" by restricting that surgeries only be performed by those who are trained (in skill and knowledge) to do them?

The Health Care Industry isn't this clandestine group of shadowy figures trying to oppress and bilk the public. It's people like me---a 29 year old who is tired of living in poverty so I decided to go to school to better myself and my life prospects. I have taken Pharmacology. If I get my master's degree in nursing and become a nurse practitioner, I too will have prescriptive authority just like an MD.

Who decides it's dangerous---well, the FDA does through years and years of required medical testing. First, the drugs are tested on animals, then on a select group of humans, then larger and larger populations until the drug is deemed safe for public consuption. Of course the FDA isn't sterling and perfect when it comes to their approval of Rx drugs, but you have to look at the practicality of the issue---drugs are in testing for 5+ years......after that, they're either considered safe or not safe. Of course no one can tell the ramifications of a drug if it's taken for 20 years, or in combination with 10 other drugs, or taken by a person with X disease. That's not to lessen the burden of the FDA who has authorized many drugs as being 'safe' when they're not (see: Vioxx, etc).

Your Doctor isn't out to get you. Health Care workers aren't boogeymen looking to line their pockets. As a nurse, I will make the same salary if you take your high blood pressure medicine than if you don't. I make the same salary if your meds cost $.02 a pill or $40 a pill. I will prescribe for you and advise you to take whatever medications are necessary to aid in your recovery or safety or continued well being.

Anyone can get into Nursing School. Anyone can get into Pharmacy School. Anyone can get into Med School. If you can pass the pre-req's, and pay for the classes, you can get in. Take a beginners pharmacology class. See why drugs are regulated. I can't even BEGIN to tell you how much we have to know regarding side effects, drug-drug interactions, contraindications, method of use, reasons for use, toxicolgoy, etc JUST FOR SIMPLE MEDS LIKE ASPRIN AND TYLENOL.

No one is restricting your right to anything. If you feel that YOU MUST HAVE A HEART MEDICATION and your doctor is telling you that you have no heart condition, and you have no reason to take a heart medication, I see no plausable explanation as to how your freedoms are being restricted, or how the government is "keeping us down" by regulating highly potent and in some cases very toxic drugs.

Look at how many people die by overusing OTC medications. ASPRIN CAN KILL YOU and that has been OTC since God was born. There is no such thing as a safe drug, and the more dangerous a drug is, the more it should be regulated as to who takes it. Let me rephrase---the more dangerous a drug is, the more insistent the Government should be regarding patient teaching, education, etc regarding that drug.

I see patients ALL THE TIME who refuse to follow simple directions regarding over-the-counter medications. "Gee, the instructions say take 2tb of Robitussin for a cough. I feel extra bad, so I'll take 1/2 a bottle" then come in because they're dizzy and faint and freaking out. Or "Hmmm...1 asprin gets rid of my headache. I have a migrane. I'll go ahead and take 5 and then go to the ER because I'm bleeding out of my rectum"

Medicines aren't candy. They shouldn't be treated as such. I'd suggest you go to any bookstore and buy the Professional Version of Davis' Drug Guide, or the PDA, or any other drug handbook that is designed for medical personnel. Look up "Acetominophin" which is Tylenol (OTC drug). THAT DRUG ALONE TAKES UP FIVE PAGES OF CAUTIONS, SIDE EFFECTS, CONTRAINDICATIONS, AND DRUG-DRUG REACTIONS.

Now, look up something much more "dangerous" like Digoxin, a heart medication. TEN PAGES of warnings, reccomended doses, signs of toxicity.

Now you tell me that YOU trust 99% of Americans to make THOSE kinds of medical decisions on their own regarding medications to take. You make that decision, and you will have the deaths of millions of Americans on your hands my friend.

[The Straight Story]

25. Which goes to the heart of my original ideal/question

Leaving the decisions for the rest of us to the real experts and law makers. Most of us know little about medicines and their effects, and the federal government knows the majority is too ignorant to do things right - so they limit our choices through legislation.

How far does this extend, and how much arm chair quarterbacking is going on from the rank and file? Not just on the medicine, that was an example question only to illustrate a point/question.

Those we elect make the rules we live by, and from drugs to the environment they know best it seems. How right are they and how far does this all extend into other areas?

[Heddi]

27. Most people know little about anything other than what they know

I don't know a damned thing about airplanes, and it's a good thing that I'm not allowed to build them.

I don't know a damned thing about performing surgery, and it's a good thing that I'm not allowed to perform surgery.

TO me, it seems like you're talking in circles. You asked if all drugs should be unregulated and allowed to be purchased OTC. I'm a medical professional, I said no, and I explained in detail why. Others on this thread say the same thing, yet you keep asking about "real experts"....don't you understand that DRUGS ARE DANGEROUS WHEN TAKEN IMPROPERLY.

PLANES ARE DANGEROUS WHEN BUILT BY PEOPLE WHO DON'T KNOW ONE WHIT ABOUT AERONAUTICS OR ENGINEERING

There are always going to be professionals who know more than you do, who know more than I do, and who are going to be better at something than the rest of us are.

Just because there are people with doctoral degrees in this or that doesn't mean that they're trying to 'squeeze out' any competition. It just means that certain things like drugs, engineering projects (airplanes, bridges, buildings, tunnels), medical services...those things SHOULD be regulated because they're quite ineffective and dangerous not only when they're NOT regulated, but when untrained people are allowed to build/prescribe/perform surgery.

And "they know best" is a logical fallacy, I suppose. WHO is "they"? The right-wing doctors who don't discuss abortions? Or the left-wing doctors who operate on poor people in third world countries. You paint "everyone" who has any kind of authoratative knowledge with this broad brush of deception and duplicity. That's just not the case.

I would say that for the most part, the people who are prescribing your drugs (the doctors and Nurse Practitioners) are looking out for your best interest. Pharmaceutical companies don't prescribe drugs. They develop, promote, and distribute them to pharmacies. There are Doctors and Nurses and Researchers that work for the pharmaceutical companies. That's how the drugs are tested. Doctors test the drugs. Researchers extrapolate the information.

I really don't understand your point. Are you suggesting that NOTHING be regulated in ANY way because SOME people may abuse their power and not look after the collective good of Americans/Humanity? If that's the case, then I can do nothing to disuade your view.

I would hardly suggest there be no regulation to ANYTHING. Would *YOU* live in a building that was built by someone with no engineering training? Would you fly in an airplane across the atlantic piloted by someone who never went to flight school, in a plane built by someone with no understanding of aeronautics or engineering or physics? Would you take a medication not knowing what it was for or how it affected your body? Would you allow someone with no medical training to perform surgery on you?

I would hope your answer to all of the above would be NEVER, but that seems to be just the thing you're suggesting.

If this is not your position, then please try to clarify because that is precisely what you're coming off as saying.

[No Exit]

21. No, why should we?

The damned pharmaceutical companies are hawking every drug imaginable directly to the public. So this means they, the experts, think we, the public, have the education, experience, and intelligence to decide which prescriptions we take. So therefore, who needs a doctor?

Let's put it this way: as long as those bastards are allowed to bombard the ignorant (sorry, but compared to doctors/pharmacists, most of us ARE comparatively ignorant on the subject of drug chemistry) with their cheezy ads for prescription drugs, then we, the public, should be allowed to just go down to the drugstore and buy whichever drugs' ads appealed most to us.

[Heddi]

23. Then will you hold yourself responsible

if you start bleeding profusely in your brain because you took a heart medication for a heart problem you didn't have, or took a higher-than-reccomended doseage because there was no Doctor to tell you that taking 0.25mg too much per day of a certain medication can make you bleed in the brain?

Medications are regulated for a reason. There is no safe drug. Every drug has side effects and most medicines WILL kill you if taken improperly.

Yes, the pharmaceutical companies are evil, as are insurance companies (I'm not being a smart-ass). But people are NOT going to read a 5-page section in Davis' Drug Guide to see what meds counter-react with other meds. They're not going to have labs drawn that are necessary for certain meds like Heparin, Coumadin (both promote bleeding), Digoxin (a heart medication). THESE MEDICATIONS ARE DEADLY to people who do not know how to take them, take them without reason, or take the wrong amount.

Drug reform is needed. So is health care reform. But making everything OTC because Rx prices are too high is just ridiculous. You are risking the lives of millions of Americans who are too lazy, too dumb, too ignorant, or just plain not interested or capable of reading 10 pages of medical mumbo-jumbo to find out how much of one medication to take over another.

I posed this question above:

Surgery is expensive. Why don't we just cut out the middleman (surgeons) and let ANYONE perform surgery that wants to. Why not just let anyone with a knife and some band-aids perform open heart surgery. It'll cut down on the price of surgery, bring some competition to those "know it all" doctors. By regulating surgery and who can perform surgery, we're just keeping the American People Down(tm) and cutting off their surgical choices. Hell.....let Uncle Bob give you a kidney transplant---he's skinned some deer in his time, he knows what he's doing. I'm sure he can find the instructions online and do an adequate job, right? :eyes:

[Djinn]

26. We have a winner

I'm also no fan of pharma's but understadn that despite being a relatively intelligent person I know sweet F-All about drug chemistry and metabolism etc etc - I don't even know the corerct names for the things I don't know!!

Yes, the pharmaceutical companies are evil, as are insurance companies (I'm not being a smart-ass). But people are NOT going to read a 5-page section in Davis' Drug Guide to see what meds counter-react with other meds. They're not going to have labs drawn that are necessary for certain meds like Heparin, Coumadin (both promote bleeding), Digoxin (a heart medication). THESE MEDICATIONS ARE DEADLY to people who do not know how to take them, take them without reason, or take the wrong amount.



just had to quote that coz it's so well put it should be repeated!

[Heddi]

28. I'm in nursing school and the BASIC PHARMACOLOGY

that I have to learn is mind blowing. I've got THREE pharmacology books and the knowledge that is needed not to prescribe (since as a nurse, I don't have that authority until many, many more years of schooling), but just to MAINTAIN people who are taking certain medications.

Digoxin, which is a medication I"ve mentioned several times in this thread, is very very widely Rx'ed for various heart problems---heart failure, heart attack, irregular heart beats. The med has been around since time began, and it is SO DANGEROUS if taken improperly. Any patient who leaves the hospital with an Rx for Digoxin is REQUIRED to have both a Dr AND A NURSE go over drug education for that patient.

If your Blood pressure is too low when you take it, you can die
If your blood pressure is too high when you take it, you can die
If your pulse is too low, you can die
If your pulse is too high, you can die.

The general "therapeutic" amt given to patients is 0.25mg a day.
The Toxic dose (one that can send a patient into overdose which can and is fatal in many many instances) is around .75mg. It's a very dangerous drug if taken improperly. That's not to say that it's not a valuable drug--it is, as it has saved MANY MILLIONS of lives. But it can kill you if you take too much.

Also, it is counterindicated with NUMEROUS drugs, and many drugs can increase the toxicity of Digoxin.

Look at Asprin--very common---and very much available without a prescription---but it kills THOUSANDS of people a year because it's either taken improperly, or taken with drugs that are counterindicated with asprin use.

It seems very common sense to me.

[No Exit]

30. I was being facetious.

A pet peeve of mine is those CONSTANT, ridiculous, annoying ADS FOR PRESCRIPTION DRUGS! WHY are these things being hawked to average citizens when it is NOT average citizens who decide which drugs are to be prescribed??

At the end of the VP debate, almost as an aside, John Edwards said something like, "And we're gonna do something about these prescription drug ads, which are OUT of control!"

Even if I hadn't been ready to vote for him, which I was, that ONE statement alone would have won my vote for him! I want the damned prescription ads off my TV! (And yes, I know where the freakin' "off" button is... but I don't watch the thing for the commercials, I watch it for the programs.)

[Liberal Veteran]

29. Certain drugs: Absolutely.

There are literally hundreds of drugs on the market to treat literally hundreds of conditions.

People are trained to know what drugs are for what at at what dosage and if there are any interactions with other drugs or are appropriate if you have other co-morbidities.

Some drugs cannot be substituted generically even though they are supposed to be chemically equivalent.

Take coumadin and warfarin as an example. Both are the same drug, but the dosage of drug that you take is based on certain blood tests.

So you go into the pharmacy and decide to switch out coumadin for warfarin because this week the warfarin is cheaper. Unfortunately, for some reason, warfarin behaves differently than coumadin in the body (even though logically it shouldn't, but it does, and it's been documented) and they have to repeat the tests that determine your dosage.

That's one.

HIV is another. Taking HIV medications requires regular bloodwork and tests to make sure the drugs are working and that there are no unseen side effects (such as kidney or liver damage resulting). One of the very GOOD things about presciptions is that it basically forces you to go to the doctor for that routine bloodwork that will determine if the drugs are still effective or if they are damaging your organs.

I spent the last year or so learning just how to dispense prescriptions safely.

While there are some drugs that I feel should be OTC (and usually they do end up OTC after some time), others are just far too dangerous to dispense without a doctor's supervision.

Can you imagine the Pandora's box that would be opened if someone checked their blood pressure in one of those self test machines and it read a bit high (but the person didn't realize that it was because they were on a cold medication). So they pick up some blood pressure medications (of which there are dozens) and start self-treating themselves for a disease they don't even have, complete with some VERY nasty side effects of those drugs.

Personally, I think it would be too great a danger to public health to just throw open the pharmacopeia to the masses without needing a doctor's note saying they need it.