It could be something Jim o Neill could try to do
1 Like
Because lobbyists pay lots of money to keep things under the control of pharma companies, insurance companies, medical providers etc. Direct to consumer would enable lots of competition on drug pricing, and most of those people would end up losing out. That’s my cynical take.
5 Likes
I like this too. My AI diagnoses me, go grab the drugs and you’re done.
3 Likes
This is not going to be a popular opinion, in fact it’s not even popular with me, but there are good reasons why at least some meds should be prescription only. The fact is, that on a societal level it’s sensible, because the vast majority of people are not equipped to make decisions about taking drugs, and it would turn into a disaster on both a societal level (think inappropriate use of antibiotics that destroy their usefulness for everyone), and individual, many are powerfull poisons in the wrong hands. Can you imagine the mayhem? People can’t handle food, let alone powerful meds. On a societal level it would simply not work. This sucks for those of us who would benefit from OTC meds, because we are often better equipped than our PCPs to make such decisions (and we self-prescribe through India etc. anyway), but we are a tiny minority.
Not that the current system works particularly well either. And it absolutely is also a money making scheme. There’s no good reason why many meds are not OTC (e.g. statins), and even so, many PCPs make poor medication choices anyway, either from ignorance or driven by monetary incentives.
It’s a balancing act. On a societal level, access to some medications should have safeguards built in. Look at the opiate disaster. Whether gatekeeping by MDs is the best way is debatable, but the need itself is not. Again, that may not apply to many people on this site, but public policy is - or should be - made for the society as a whole, and inevitably tiny minorities such as us will get the short end of the stick.
What’s nasty is shutting down any options altogether, such as the FDA banning any and all imports of unscheduled meds for individual use - that’s pure economics, a power grab, and a restriction of individual rights, IMO. YMMV.
5 Likes
Yea I think some drugs should for sure be RX only for obvious reasons but then you have things like Metformin and Tadalafil that absolutely should not be RX only.
2 Likes
It’s not just politicians. It’s the voters who vote for those kinds of politicians. Same rule applies to all of these lovers of “free speech” who are the very first to sic the government on anyone expressing an unpopular opinion, the ones who cry loudly about “cancel culture” immediately trying to cancel and fire holders of opposing opinions, the huge lie about personal freedoms and small government where they ban you from voluntarily taking drugs into your own body, get the government between a woman and her doctor, try to limit reproductive freedom, decisions about their bodies, intrude into the bedroom, impose religion, and the list goes on. It’s all LIES. The reality is they’re all about control - full stop.
2 Likes
Speaking from the standpoint of a physician, I’d love to see several medications become otc. The risks are comparable to current otc meds. Of course people will still want prescriptions so they can get someone else to pay for them.
5 Likes
Exactly… remembering the days of a flonase prescription. Was ridiculous. Such a hassle every allergy session.
Tadalafil, Finasteride, Doxycycline, Minoxidil… all could br otc.
But true… insurance covers a lot of the cost.
1 Like
What medications would you like to see become OTC?
1 Like
For many reasons mentioned here, I think a good compromise would be that medicines need a doc to prescribe them for things that are long term, like a statin, and after you get the green light, you never need an rx again (unless it’s a good for all type of thing that @KarlT has in mind). And perhaps things that need to be short term, similar to an antibiotic, those don’t become otc to prevent people from misusing them.
Some (definitely not all) docs will only give you rx’s for a few months which forces people to go for another visit they can’t easily afford for no valid reason. it’s a pitiful system.
A tough question because some people are going to be either intentionally irresponsible or just ignorant, bu that could happen with current otc’s. Could try what some other countries do which is a class of meds termed btc (behind the counter), in which you don’t need a prescription but the pharmacist will help you.
I’d consider the following meds for otc:
All statins
All full strength PPI’s
Metformin
Albuterol
Zofran (big impact on decreasing clinic visits)
All E.D. Meds
All contraceptives
The biggest debate would be about antibiotics as these would be overused and increase antibiotic resistance.
5 Likes
Thanks, do you have significant concerns about the push for ivermectin and hydroxychloroquine being OTC in red states?
In India and Thailand, these medications are OTC
Antibiotics: Amoxicillin, Azithromycin, Ciprofloxacin, Metronidazole
Contraceptives: Oral Contraceptives
Antidepressants: Fluoxetine, Sertraline
Opioid Painkillers: Tramadol, Codeine combos
Benzodiazepines/Anxiolytics: Diazepam, Alprazolam, Lorazepam
Hormone Replacement Therapy: Conjugated Estrogens
Antidiabetics: Metformin
Corticosteroids: Prednisolone
Erectile Dysfunction: Sildenafil**
2 Likes
Surprised about PPIs being in that list! Omeprazole is already OTC and all PPIs are IMHO wildly overprescribed. People are on them for years of their lives for no reason and long term use leads to osteoporosis/nutrient malabsorption, gut dysbiosis and increased risk of dementia. Sure they are “safe” drugs short term but incredibly hard to taper off and have serious long term risks.
Don’t have a problem with the rest of your list but I personally ended up in the ER with dystonia from Zofran so I won’t take it anymore. That would have happened regardless of it was OTC or not and I would have been in the ER just the same, though.
1 Like
As with so many things - in fact, freedom itself - there’s a premium on understanding the choices. The less you know about a medication, the less valuable is the status of OTC. To take advantage of the freedom of choice, you must be reasonably well informed, otherwise you’re better off having someone oversee the choices. The government has decided, through the FDA, that the population at large is not well informed, and so they’re stingy with OTC.
1 Like
Well, from my cursory examination of the USA, it appears the general population is not well informed on medications and many more things in general.
3 Likes
Sigh, it was just the other day that someone who does some work for us asked me what I thought about glp1’s.
She was at a spa and they had a sign that said it would good for inflammation and heart disease.
“My tummy has been hurting and I have high cholesterol, so do you think I should get these injections to help?”
As you can imagine, I was so upset by how people are trying to take advantage of those who don’t have enough information.
It was a perfect argument of why these should only be offered by doctors (even though, at the same time, I’m against that idea).
Just an aside, another person just shared they were told by their doctor they could not have hrt because it’s dangerous to start after the age of 60.
3 Likes
A gross understatement. As P.T. Barnum said: “No one ever went broke underestimating the intelligence of the American people,”
1 Like
Definitely concerning as these have significant adverse effects.
2 Likes
I am of the oppinion that all drugs should be available to any consenting adult provided they give written consent stating that they take full responsibility for their health and will not harm others. That would include a statement that you take responsibility for being well informed or to at least get advise from experts that are. Also that if they harm others indirectly through their actions (e.g. by abusing antibiotics thereby contributing to antibiotic resistance) they will pay fines to compensate for the harm.
I don’t see why any drugs shouldn’t be available to people that consent to this. Those that say that people aren’t well informed or can’t be trusted to make decisions about their health? So what? What if they want to do it anyways? It’s their body after all. What if someone wants to take risk or even harm their body. Why shouldn’t they be allowed to do so as consenting adults?
The only good reason I see to not allow people to not do such things is if they don’t take responsibility. So the solution to all these problems is responsibility. I think it’s ridiculous that adults are allowed to ruin their health with smoking and alcohol and risky activities but are not allowed to take drugs because they might harm them.
3 Likes
I think in Portugal all drugs are legal… has been for over a decade and no issues.
Granted most think of recreational drugs like ecstasy and cocaine… not sure of other stuff like rapamycin. If so, would be a great drug vacation… destination.
2 Likes