[tptacek]

The basic argument is that when you make seeing a doctor to get access to a drug optional, you also make it a luxury; it changes patient expectations and thus behavior.

Most people don't go to the doctor before taking Claritin or Sudafed; when you go to the doctor and get a "script" for Sudafed, that's your signal that you wasted yours and the doctor's time.

[tcj_phx]

You have a very good point about patient expectations. But patients have been trained to expect a prescription for magic pills from the doctor, and the doctors do their best to oblige, even when they ought to recommend a lifestyle intervention... As you note, people think they've wasted their time (and money) if they only get a recommendation that doesn't need a prescription.

The tragedy of the situation is that most prescriptions aren't as effective as marketing campaigns lead people to believe. For example, statins are good for improving patients' cholesterol lab #'s, but make them achey, and only prevent a handful of heart attacks for every 100 patients treated (statins have a poor 'number needed to treat' [0] ratio).

[0] https://en.m.wikipedia.org/wiki/Number_needed_to_treat (the section titled "simple example" says ~98 people had to take the studied cholesterol drug for 3.3 years to prevent one cardiac event.)

Number needed to harm is another important factor. All patients were harmed by DES [1], before it was withdrawn...

[1] https://en.m.wikipedia.org/wiki/Diethylstilbestrol

[wiz21c]

FTA,

>>> Americans may soon be able to get cholesterol-lowering medications

Going to the doctor to get such a medication is one more occasion to be reminded to check your diet before jumpin' on pills...

For the newly available medication, I'd suggest to raise their price by half the price of going to thte doctor to get the script. That money would then be given back to social health care system :-) So the patient pays less, have more flexible access to the medication and healthcare system benefits too :-)

[ant6n]

> The basic argument is that when you make seeing a doctor to get access to a drug optional, you also make it a luxury; it changes patient expectations and thus behavior.

It seems in the us, seeing a doctor already is a luxury.