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

Sheepish that I missed that. Carry on.

Feels like y'all are actually pointing at the same uncomfortable truth from different angles - that medicine is both incredibly helpful and very fallible. The “docs get it wrong sometimes” stories and the “these drugs are powerful and complicated” concern aren’t really contradictions - they’re two reasons this is a hard policy question.

Part of me says the real question isn’t “trust vs don’t trust”, but where the guardrails should sit given that humans (patients and clinicians) are imperfect and there’s of course a version of this debate that isn’t about who’s naive, but about how much friction we want between people and powerful tools.

The other part of me wants to lean into the trust issue & engage the questions of what would make health professionals and institutions more trustworthy, but maybe that can be blended too, because I think there are some limitations to human improvement and that well-calibrated guardrails in themselves might help the distrust problem, but it's more complex than just that, because our odd information environment sometimes distorts our judgements of trustworthiness.

quote:

---

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

---

You can’t be serious.

quote:

---

Feels like y'all are actually pointing at the same uncomfortable truth from different angles - that medicine is both incredibly helpful and very fallible. The “docs get it wrong sometimes” stories and the “these drugs are powerful and complicated” concern aren’t really contradictions - they’re two reasons this is a hard policy question.

---

I agree with you. My point was that he is saying DRs get it right due to the training. And they do not.

And $$$$ do dictate what many do. For example, they will do a stress test for heart first. That costs money. Then they move on to the next. and the next. When they could have just started with the test that would just clear the heart as the issue.

And it's very common. My neighbor went to 3 hospitals because he was in so much pain. Every one of them sent him home with bandade fix. The last decided to actually do something. It was to late. literally gangrenous gallbladder by that point. He's dead.

I can go on and on. It's a massive issue.

My niece is a professional dancer. Her partner over shot her and she hyper extended her knee. She knew something happened. So she went to the hospital and DR had her sit and he moved the knee/leg. "You just strained it". Put her in rehab against her objections and her telling them it's not a sprain. She kept telling him that it's not a sprain and he got a little pissed and told her he knows what he is doing.

She went and got an MRI. She had 2 tears. Long story short, he came in and said "well it looks like it is torn". She told him off and told him to get out he would never handle her case again.

All because he did not understand that the knees and the muscles around the knees of a dancer are extremely strong. Had he done an MRI to begin with it would have saved her money and time.

quote:

---

Part of me says the real question isn’t “trust vs don’t trust”, but where the guardrails should sit given that humans (patients and clinicians) are imperfect and there’s of course a version of this debate that isn’t about who’s naive, but about how much friction we want between people and powerful tools.

---

I don't think this is a case of everything being OTC. There are things I don't need a DR for.

The argument that if they were available would result in a super bug or people dying in the street is hyperbole. Again, I can literally order from pharmacies overseas without prescription. Yet they don't have masses dead in the streets from it being OTC.

quote:

---

The other part of me wants to lean into the trust issue & engage the questions of what would make health professionals and institutions more trustworthy, but maybe that can be blended too, because I think there are some limitations to human improvement and that well-calibrated guardrails in themselves might help the distrust problem, but it's more complex than just that, because our odd information environment sometimes distorts our judgements of trustworthiness.

---

Solutions only happen when we agree there is a problem. Then we can offer what seems to solutions and bounce those ideas off of others. To the topic, I see nothing wrong with OTC drugs. I do see a need to place guard rails. What that looks like in the future is being talked about.



BTW.. I actually like this TigerDoc and conversations like this.

quote:

---

Appreciate that, and I think you’re putting your finger on something important - most people’s views here are shaped by the cases that stick with them, especially when the system feels slow or dismissive. The hard part is that medicine has both incredible successes and very human blind spots, and people tend to encounter one or the other more vividly.

---

I agree, but I will add that the system is designed to make the most money. Like with heart issues. Stress test will always be first line. Yet is misses roughly 35-40% at a cost of $3,000–$5,000 or more. CT angiogram has the highest rate of success. And it's the same cost. Coronary CT Angiography is has a higher rate of successful diagnoses. And it's half of the cost.

So why are we wasting people's money when we could save it and get it right the first time?

quote:

---

Sounds like we probably agree that the interesting question isn’t whether problems exist, but how to design systems that catch mistakes without making access impossible (which is easier said than done).

---

100%.

quote:

---

These kinds of conversations are rare online, so I’m glad it’s staying thoughtful.

---

Another truth.