[andymism]

> diabetes patients test their own blood. If they need more insulin, why does a doctor have to prescribe it

In many states (California is one) you can by certain brands of insulin OTC. The limitation is more a decision of the manufacturer than it is codified into law. Pharmaceutical companies are well known for milking their patents as long as they can and then lobbying hard for OTC status as soon as the end date on their patent is coming up. This gives them the opportunity to continue to push their brand and squashes any competitors who are still behind the counter.

You need look no further than allergy medications for an example. Claritin and Allegra were the biggest brand names in prescription allergy medications just a few years ago. But as Claritin's patent protection period was ending, its makers pushed hard to go OTC. And they did. The result is that Claritin dominates the OTC allergy medication category while Allegra is no longer covered by insurance plans because an OTC alternative is available. It's easy to guess what this did to Allegra's market share.

> There are lots of conditions where it is easy for the individual to maintain their own medications

Maintain is the key word here. OTC availability is only half the story. Your comment makes the assumption that someone knows that they're developing some sort of condition, say diabetes, in the same way they know they're coming down with a cold. How do you know you're becoming diabetic without a doctor's examination and follow up? Are you just going to know think one day that "Hey, maybe I'll google why I feel tired all the time and have been bruising easily lately..."

I know that the medical system is under a lot of fire these days and it's everyone's favorite axe to grind, but some good reasons that prescription control is necessary is to (1) control easily abused substances (this means narcotics as well as antibiotics, though the litigious culture here in the US is quickly rendering traditional antibiotics useless) and, probably most importantly, (2) maintain communication with your healthcare provider. Doctors use prescriptions in order to monitor your compliance and require (at minimum) annual visits so they can check up on you, even if it is only for 5 or 10 minutes. Maybe that decrease in energy is a side effect, or even that occasional but not cold related cough. Your doctor will recognize this and will be able to suggest changes. You probably had no idea a cough was a related side effect. Even if you did, did you keep up on any of the literature for the class of drugs you're taking in the past year? I doubt it. You have better things to do with your time.

> Doctors know a lot, but all doctors don't know everything about every medical condition.

You're right about that. But that's why we have a system of specialists. Even a less than average doctor will refer you up and down that chain until you're dead, out of money, fixed, or have found a way to live with it. It's like throwing a reverse exception where it gets passed from the most general to the most specific handler. Or a search tree where the root is the most general case and the leaf nodes the most specific. Of course it could be more efficient: science could be more advanced, doctors could be smarter, insurance companies more willing to pay, and patients less litigious. But the way doctors handle medical cases has evolved this way because it can solve the most common cases the fastest. And the rare cases, the exceptions? Well, they're rare and the exceptions.

The reason you see so many cases of patients out diagnosing doctors on TV is exactly because they're the rare, man-bites-dog kind of story. How many lottery losers do you see on the nightly news? Safely landing planes? How about stories about cars not piling up in bad weather? My advice to you (though you don't want it) is to stop watching TV. Or at least, stop watching TV and then using what little information is conveyed to make generalizations about the world and how society should be run.

--

What became obvious to me from reading your comments is that you don't know what you don't know and that you assume that what you don't know is trivial. There is an unprecedented wealth of information at our fingertips. That's a cliche. But no number of articles read on Wikipedia, no number of Google searches, or stays at a Holiday Inn Express can replace the actual practice of medicine.

[_delirium]

I agree on the last part there that there is lots the average person doesn't know. But one can also easily overestimate the knowledge specialists have, as they often don't have that knowledge either. Most doctors I know shudder at the thought of entrusting their lives to many of their med-school colleagues, and will off-the-record go on and on about how many doctors are 10+ years out of date with their knowledge of current medical literature, and how much cargo-cult "well this is how we do things" medicine is still prevalent, despite the attempts of EBM to wipe it out. Most also recommend that I do my own research before believing any doctor, though that isn't the advice they give their own patients.

I don't think it would necessarily be the case that a smart person with access to a good library couldn't do a better job self-diagnosing for a wide variety of routine conditions, especially since they would be willing to put in more research than the average doctor does. We're not talking about performing your own heart surgery, but more like the 80%+ of cases where the correct thing to do is a relatively routine decision that depends more on diligence in research and being informed about current best practices, than on any specialized skill. There are computer programs that can outperform the average physician in many areas (though not necessarily the top doctors; but you aren't likely seeing the top doctors, either). The self-diagnoser also has one key advantage, in that they are (presumably) only interested in their own well-being, not in defensive medicine and fear of malpractice suits.

Of course, it does require being a relatively level-headed person who knows how to read the relevant literature. Excitable folks, people who have never read an academic-sounding paper, and hypochondriacs are probably all better off not self-diagnosing.

[andymism]

I agree that, in general, you should educate yourself about what your doctor is telling you and push back a little bit. It's probably a good practice of any thinking person.

Routine conditions are a case where self-diagnosing will yield adequate results most of the time. But outside of the most common conditions, a smart but not medically trained person will end up treating symptoms rather than causes. A good example is blood pressure. You can walk into any pharmacy and find out within a minute if you have high blood pressure. For 80% of cases, you could probably just look up the most popular generic medication, start at a low dose and adjust a month at time until your blood pressure is normal. But what about the underlying cause? It could be an endocrine system problem, enlarged heart, arterial narrowing of the blood vessels from the kidneys, or ion channel exchange imbalances, to name a few. It is routine for a general practitioner to check for these and other causes and interpret the results of their tests, but is decidedly not routine for most smart people.

[ippisl]

I think you overestimate the ability to self diagnose objectively. i heard that medical students , while learning about medical conditions , start to see symptoms in themselves , and believe they have all kind of illnesses.

So collaborating with your doctor seems like a better path(especially since he has access to various tests).

[fnid2]

It's called "Medical Student Syndrome." I learned about it in psychology class because it happens there too.

[yummyfajitas]

Or, we could give patients direct access to various tests without the permission of a doctor.

[HeyLaughingBoy]

How would that help? How would you know what tests to order? How do you interpret them? How do you know that if test A has a certain result, then test B should be ordered to check for cross correlation with something else?

It's really easy to say "just order my own tests" but the reality is that it would be pointless for most people except... trained medical staff!

[fnid2]

Doctors can't really check up on patients in 5 or 10 minutes, that's part of the problem with requiring the checkups and it fosters resentment in the patient who has to pay $200 for the visit and wait 2 hours past the appointment time in the office.

As others, and I, have said in other comments, prescriptions are not required in all countries and people aren't rushing to the pharmacies to OD on viagra. I don't know why the argument that we need to protect patients from themselves is so popular, because it simply isn't true and that has been proven practically in many countries around the world. I don't know if you know this, but the law requiring prescriptions was only created in the 50's and it was created because of a couple of people making some mistakes and hurting themselves and that case was used to justify the huge, sweeping law that we have today. In effect, a tiny outlier was used to justify massive change to the general population, which didn't have the problem.

Lots of people continue to die from misusing OTCs, everything from Tylenol to Lidocaine to Aspirin, yet we don't put those back behind the counter. Parents kill their own children by giving them aspirin when they have a virus, here's info on that: http://en.wikipedia.org/wiki/Reye%27s_syndrome If your child has a cold, don't give them Aspirin!

People actually do care about their lives and their health. Yes, there are some that are going to abuse drugs, but requiring prescriptions for them doesn't stop that abuse. People don't stop abusing cocaine, marijuana and heroine even though you can't even get them with a prescription (outside some progressive states anyway). Many argue marijuana is still illegal to protect pharmas, but I don't know. Anyway, it's moot, because I don't care if people abuse drugs. No one seems to care that people abuse money or sex or food and those cause lots of problems for entire societies -- much more damaging than someone popping some pills and going to a rave -- which actually may be good for society.

For the record, I don't watch that much tv, but that's beside the point.

The point is, the individual should be sovereign over the self. No one else should tell me what I can and can't do to maintain my own life and no one should be able to force me to give someone else my money in order to maintain it. If I want to continue living, I should be allowed to obtain the drugs I need to do that as long as I'm not hurting someone else.

For over 15 years I've been a victim of this issue, I've studied this issue, and I've traveled to other countries where this isn't an issue. All the arguments I've ever seen supporting the status quo in the U.S. simply aren't valid. The claims that are made to support it have been tested in other countries and the facts contradict them.

Also, what's with the trend lately of people telling me they know more about what I know than I know? You don't know what I do and do not know. Seriously, you need to stop being so arrogant. It just may be that I know a lot more about this topic than you do. One thing is clear to me: I don't need your advice.

Final point, practice does make perfect, but you could say the same thing about computer programming: No amount of wiki or google will replace the actual practice of computer programming, but for people who have chronic illnesses or well known conditions, they have years, sometimes decades of practice managing their illnesses and that could, in fact, be longer than many doctors have had practicing medicine on their condition, which supports my argument.

[yummyfajitas]

but some good reasons that prescription control is necessary is to (1) control easily abused substances (this means narcotics as well as antibiotics, though the litigious culture here in the US is quickly rendering traditional antibiotics useless) and, probably most importantly,

This is only an argument for requiring prescriptions for narcotics and possibly viagra. This argument is completely invalid for any drug which isn't fun to use, such as birth control, amebiasis pills, anti-fungals, etc.

(2) maintain communication with your healthcare provider.

This argument is completely invalid for any drug which doesn't require long term uses (e.g., anti-inflammatories, amebiasis pills).

Many other countries allow many drugs to be safely given out OTC with no adverse side effects. The only reason for maintaining our current system is to preserve the privileged status of doctors and regulators.