re: FDA Chief wants all meds to be over the counter unless addictive

I have always wondered why I can walk into almost any store in a foreign country and buy off shelf what I have to pay a $75 co-pay at a medical clinic to purchase here.

This will cut medical and pharmacy costs.

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This will cut medical and pharmacy costs.

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100%!

The “middleman” are directly leading to the closure of mom and pop pharmacy’s all over our nation.

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Perhaps OTC antibiotics are just what is needed for the successful development of new one’s.

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I have always wondered why I can walk into almost any store in a foreign country and buy off shelf what I have to pay a $75 co-pay at a medical clinic to purchase here.

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This seems like a bit of hyperbole.

Are more drugs available over the counter in other countries?

Are drugs that cost us $75 with insurance even available at a standard pharmacy in Mexico? Probably not.

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Physicians and pharmacists will fight this tooth and nail, not for your safety but for their professions.

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LMAO. Pharmacies make more off OTC than they do prescriptions. We call in most of the shite for free, as a physician, I welcome it. I have plenty of business without having to deal with every sneeze, sniffle and fart someone has.

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And those are the drugs we should start with. Western Country X has sold viagra/amoxycillin/whatever OTC for 10 years. What's happened as a result? Good, bad, worth it, not worth it? We have ready made case studies for at least some drugs.

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For the record, I'm not saying there are no drugs that shouldn't be reclassified to OTC. And I'm also just fine looking at data from other countries (if good data exists). Maybe I'll be surprised; maybe people picking their own medications gets better results than doctors picking them. But I doubt it.

There's a reason that doctors have to go to school for as long as they do and why pharmacy programs are as competitive as they are.

For example, everybody keeps bringing up antibiotics. As though that's a monolithic drug.

But there are well over a hundred different antibiotics in about 17 or 18 classes in clinical use in the US.

Some types can cause a fetus to be born deaf. Others don't.

Some can impede bone and cartilage growth in children 8-12. Others don't.

Some can cause the same rhabdomyolysis that I posted about earlier when taken with a statin; others don't.

One type can't be taken within 2 hours of taking an antacid or the patient won't absorb the antibiotic. But that's only with Fluoroquinolones, like Ciprofloxacin.

Which also carries a risk of an aortic aneurism. Might be helpful for someone to know that before just grabbing it off the shelf.

That one as well as a couple of others can also significantly raise the risk of dangerous prolonged cardiac repolerization when taken with certain antidepressants, methodone, antipsychotics, or antiarrhythmics.

Some types raise the risk of seizures when taken with NSAIDs and tendon ruptures when taken with steroids.

Calcium, iron, zinc, magnesium, and high dairy consumption can interfere with antibiotic absorption, so patients who take supplements need to stop if they are going to take one.

I could keep going on for several more paragraphs just about antibiotics, but you get the point. This is what I'm talking about when I say your doctor makes it look easy, but it's really not. It seems like he or she is just pulling a suggestion out of the air randomly when writing that script for Amoxicillin vs Azithromycin vs Doxycycline, and in all honesty, a really poor doctor might (there IS a reason that pharmaceuticals are the 3rd leading cause of death in America). But what's supposed to be happening is that the doctor is supposed to be considering the patient's history and drug schedule and picking the best specific antibiotic for each patient.

Now of course, people can Google (just like I did) all that information, but people without a medical background won't understand a lot of the terms used, nor will they understand or have any kind of frame of reference for when intervention is necessary and when it's not, or know things like a viral infection won't respond to antibiotics, or have any way to accurately check for or diagnose conditions that might be contraindicated if they don't already know that they have them.

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You can't put a bandaid on a cut? We're not the UK, we treat ourselves all the time. There's a continuum of care here, so we already have the system you appear to be scared of. This would just be adjusting the line from where it currently lies but we'd still have a continuum of care.

This is probably a good idea IF the list is carefully curated, and it would be a horrible idea of it's not. In any event it's an analog problem, not digital as you implied.

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Correct

Fair point, and I probably should’ve said it more precisely. The proverb isn’t about bandaids or routine self-care. It’s a caution about how even trained people can lose objectivity once they’re both clinician and patient once risk becomes complex (obviously not the case with bandaids).

I agree this is an analog problem. The interesting work is figuring out where along the continuum different drugs belong and not arguing for or against the continuum itself. One way to make the sorting task more concrete is to ask what kind of “friction” each drug needs:

-Labeling alone (true OTC)
-Pharmacist gatekeeping / behind-the-counter
-Time or quantity limits
-Prescriber oversight because of monitoring or stewardship (antibiotics are the obvious example)

Once you start thinking in terms of friction matched to risk rather than a single line the conversation gets a lot more practical.

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maybe people picking their own medications gets better results than doctors picking them

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Although everything you listed are important antibiotic risk considerations, creating Rx resistant bugs, C diff issues etc. probably exceed those.