I actually do think there is something to the “medication license” idea. We have to pass exams for all sorts of things. I think there should be a “med license” requirement for anyone to buy meds. You pass a basic exam just as you do to drive a car or sell real estate. Then for any med you want to purchase you also fill out a specific online application which involves you checking off information boxes about indication, dosage and drug interactions, sign acknowledging legal liability, and you’re good to go. That would result in much higher overall health awareness and education. At least you are informed. If you decide to go off label or otherwise chose a different protocol, then that’s on you. You can work with a doctor, but you buy your meds yourself.
I like the licensing idea but it would be seen as nanny state by many. A privilege of the educated elite (or wealthy - though that seems to be in favor)
Libertarian ideals are just that - ideals. Improper use of medication costs everyone money. As we all know, lots of these things are double edged swords - jardiance and UTIs as an example.
The problem isn’t prescription requirements, it’s everything else about the healthcare system.
MD bias here. We spend everyday telling people what to do. So, there is going to be a bias towards paternalism or nanny state because it is the nature of what we do. Everyday we see people misusing supplements - like excess D and winding up in the hospital or medications - taking excess NSAIDs and getting admitted for GI bleed. All of these things costs everybody money and limit positive things we can do like spend time getting a 30 year olds ApoB under 75.
I’m open to creative solutions but the government and general public is not likely to be.
Now government buying out GLP-1 patents and making them available for free for everyone that could benefit - now we are talking about real access, population benefit, and long term cost savings. Treat it like a vaccine.
Last comment about libertarian ideals. Look what it has done to health care outcomes in the US - a pretty unhealthy population. You could blame that on education and wealth inequality but you still have to fix that first before letting everyone have carte blanche access to meds.
In New York State, I can walk into Walmarts and purchase insulin (novulin) but I cannot purchase any lab tests offered by Quest. Very happy to be able to get the insulin and very angry about not being able to get the tests. I am convinced that most of the accessibility -or lack of it – is controlled by monetary interests, and have little to do with what is best for most people.
With appropriate patient education and safeguards, the majority of the prescription drugs could be OTC. Exceptions, would include many injectables, biologics, and cancer and other drugs requiring advanced competence in monitoring and dose adjustment. For many drugs, packaging containing smart patient education, including smartphone links to video training modules would suffice. For others, thyroxine perhaps being an example, the patient should present current lab metrics. For some, I would want to see other forms of demonstrated competence. Such a system could expand the OTC list considerably. I can think of several ways to manage that. For good reason, you can’t drive a car or pilot an aircraft without demonstrating competence. No . . . a dumbass self-harming move is not only harming yourself. The world is quite a bit more complex than is appreciated by such sophomoric arguments.
Most important in making this kind of change would be a scientifically sound measurement system. The last time I looked, the legitimate use of specifically prescribed drugs, taken as directed, killed ~120,000 people annually. Moving a large number of drugs to OTC status begs for sound and transparent cohort analysis.
Speaking of societal-level issues, we would want to spend some time assessing the impact of such a change on the current healthcare system – functionally and economically. I sense potential pitfalls in both areas.
This is my initial short list…
Metformin
Insulin, etc.
Statins
Ezetimibe
Bempedoic acid
SGLT1i’s
GLP-1 agonists
Triptans
Sildenafil/Tadalafil, etc.
Progestin
Emergency Contraceptive
Nitrofurantoin or Fosfomycin (for uncomplicated UTI)
Topical Retinoids
Natural and synthetic thyroxines (might require a lab for first purchase)
Topical antibiotics, including for eyes and ears
Naloxone Nasal Spray
Epinephrine Auto-Injectors
Low/Medium Potency Topical Corticosteroids
Lidocaine Patches/Creams
Terbinafine or Fluconazole (for recurrent yeast infection)
Thiazide Diuretics (maybe others)
Antiviral Eye Drops
I’m sure I’m massing many.
Yes, we know we are not all treated equally by the medical field. I believe I’ve seen the stats showing women of color are given less pain meds etc…
I might be wrong but I wholeheartedly believe I’m much more likely to be given what I want by a large majority of doctors than a different person who might be less educated or have different economic circumstance… just going to the doctor is not enough.
So for that reason, I’m piling on and I think your online system with no barrier to entry idea is perfection.
It can provide all the materials (preferably video format from a doctor) in in a simple and accessible way… and at the end of the module, it gives you a test… once you pass the test of basic understanding, you are allowed access to buy these drugs.
Perhaps this system even notifies your doctor, if you even have one, so they are at least aware of your circumstance. Or better yet, any doc or hospital can access this system to at least see what you were allowed to buy. Maybe it even keeps record of how much you purchased? I could see this being valuable if you show up to an ER for even unrelated reasons. Heck, with my mom I witnessed first hand that even when you give a hospital all the records, they still don’t look and give you the wrong medicines (don’t get my started!).
@Deborah_Hall Agree 100%
Statins need to monitor LFT’s if I remember correctly in 5 weeks, then every few months for a year, and then no longer if no change, if I remember correctly under guidelines, this wouldn’t get under Marty’s definition of what would be OTC I presume. But wouldn’t e.g Ezetimibe be without this problem and other similar drugs? (If we only approve drugs based on the criteria outlined by the FDA). I hope they don’t mean “ongoing laboratory testing” implying for efficacy measurement, that wouldn’t make sense to me.
Just a countervailing view: could it be that we (people who are on this site or other sites, trying to educate ourselves) are in a sweet spot? I think that many of us have seen that if we ask a doctor for something, and have lots of information backing up the request, that we will often get the script. Or, we can search for a doctor who will accommodate. Or we can find ways to obtain, eg. India.
My PHP kept telling me my numbers were fine. But then I presented evidence showing they were not fine, and, that I had genetic risks (“heart attack gene”,Lp(a) and others) and then he orders lots of imaging to look for aneurisms, CAC score, insulin, inflammation, etc, and refers me to cardio, (who also told me I am fine, until I opened my laptop and showed him . . .) I think if we very gently show the doctors the evidence, and give them the information they need to give the insurers, we can sometimes, not always, but sometimes get what we want. Hello Repatha!
So, we often, though not always can get many of the things we want/need, even in the current imperfect regulatory state. I am still frustrated but also acknowledge that there are workarounds and am grateful for the availability of all the empowering information here and elsewhere.
But – if everyone could get what they wanted, just because they wanted – we would probably see more incidences of abuse, harms, etc. Eventually there would be a backlash and access might become more difficult than ever.
So be careful what you (we) wish for.
We all seem to appreciate the complexity of this issue in which no path is without challenges, some of them significant. In such cases, it helps to be guided by principles that generalize well. Coming to mind for me are the following:
#1 – The burden of proof should rest with the practice that would restrict freedoms
#2 – The remedy for a lack of necessary understanding is education, not avoidance or restriction
The merits of broadly increasing access to medications currently available only via consultation with a physician is a model case for a pilot study, the empirical findings of which could then guide broader policy. Wouldn’t is be wonderful if politicians were to operate this way instead of chasing ideologically driven paths, half of which are empirically bankrupt. (Sorry for the last part – a frustrated rant.)
I have not had any success over the years getting my PHPs to prescribe meds that would help optimize my numbers. The only thing I have had success with is changing to a preferred medication, such as losartan to telmisartan.
Could you purchase tests through Goodlabs and have bloodwork done at Quest?
Believe it or not I have to have a prescription for my blood sugar test strips. Yes, test strips and they are not even a drug. Why aren’t they over the counter?
A big reason doctors are afraid of OTC is that it’s very expensive to go to the doctor in the United States (or expensive to have health insurance)
Very few people would yolo a BP medication dose if going to see their PCP was a low cost proposition. They’d either go get an evaluation or they’d do nothing at all. But as long as medical care is expensive, there is a risk of making drugs cheap and easy to get… people will skip the “expensive middle man”
To be fair, most people have insurance and regulations mandate a free visit per year. Blood pressure, once stable, is typically a once a year visit. Ditto cholesterol.
A televisit cash pay is an oil change. Sometimes less - I think I paid $10 for a retina-a script though there wasn’t a real visit. I got a CGM back when they weren’t OTC and there was no extra charge if my state required a televisit - and it did.
So, health care is expensive. Mostly because of expensive care - not because of the office visit charge of a primary care doctor.
Expensive is what happens when people don’t go to primary care.
Now, sure, a $100 office visit to get a $3 med makes it look expensive. But when it comes to statins, one free visit is all that is needed and that comes with free lab checks which are necessary anyway. And if you are sophisticated enough to start a statin yourself, you could tele for $50 and get a double dose and split it to last 2 years. Sophisticated and poor which really doesn’t happen very often.
Now I want some talmisartan and my doc doesn’t want to prescribe because guidelines. That stinks. It is also an edge case. Maybe increasing and when 30% of the population wants more aggressive healthcare than doctors are willing to prescribe, we may see changes. Hahaha. 30% - that is not happening in my lifetime. Remember about 5% of US gets enough fiber - the cheapest, safest, easiest longevity “drug”.
Doctors want people to visit them every once in a while not because of greed but because it is a good idea for their health. But sure, call it greed. Greed is Attia, not your average primary care doc.
Totally agree. And I should be clear I didn’t mean doctor’s were greedy, just that out of concern for patients they would see cheap otc meds + expensive doctor visits as an unstable combination. If you want people to come in, you need both to be cheap/easy or (worse version) both to be expensive/hard.