Dr. Andy

Reflections on medicine and biology among other things

Saturday, April 09, 2005

Patients rights

An argument, from a libertarian perspective, that "morning-after" contraception should be available over the counter (OTC):

Something is off when access to contraception depends on who is working the late shift at Walgreen's. The real scandal is not that women are being denied birth control, but that they have to ask for it. There is no reason why a woman's access to contraception should depend on a single Roman Catholic with a conscience, or why a pharmacist should have to weigh the decision between denying a woman her prescription and violating deeply held moral beliefs.

Contraception doesn't belong behind the counter; it belongs over-the-counter. A woman's access shouldn't hinge on whether she has health insurance, whether she has a doctor she can call at 5 a.m., or how her neighbors feel about the culture of life. Women should be able to order stacks of the stuff off of the internet to keep in their medicine cabinets

In my limited experience, I just called in the prescription after talking to the patient on the phone, so I don't really see why not.

In a similar vein, many patients are apparently willing to bear the risk of increased cardiovascular disease to keep taking Vioxx or Bextra.

I suspect this is the triumph of marketing over science. I am unaware of any data showing the Cox-2 inhibitors are more effective than traditional NSAIDS (which inhibit both forms of cycoloxygenase --abbreviated COX), and none of the people in the article were reported to have had GI issues with NSAIDS, which is the one advantage the COX-2 inhibitors have.

The article comically degenerates in the second half into the idiosyncratic comments of patients with minimal, if any, medical knowledge. We learn that naproxen (Aleve) makes Yankee outfielder Garry Sheffield drowsy and that Denver golfer Robert Arnold felt anixous after taking Vioxx and Bextra. No word if this only started after he learned of the cardiovascular risk. Neither of these are common side-effects of these medicines.


At 12:15 PM, Anonymous jb said...

I agree that Plan B should be OTC. So should every other drug that does not have a public health effect. Yes, that means that digoxin, Vicodin, dapsone, Flexeril, Ovral, Vioxx, and all the others with the possible exception of broad spectrum antibiotics should be OTC. The FDA could publish approved patient information on all drugs, and the manufacturers should be exempt from lawsuits if the drugs perform as described. Dangerous? Sure, just as electricity is dangerous. I can repair the circuits inside my house if I want, and I can't sue the power company if I electrocute myself. What I can do, if I'm smart, is call an electrician for anything more than basic stuff. Actually, I'm pretty handy with these things, and I would very much oppose a system where I had to get a $50 "prescription" from an electrician in order to buy a new light switch from the local Ace Hardware, but that's what our patients have to do to get the meds they need. I don't doubt that there would be excess morbidity compared to the present system if all drugs were OTC, but if that's the criterion, I should not be allowed to replace my own light switch, and you should not be allowed to drive a motor vehicle.

At 12:33 PM, Anonymous jb said...

Another point: if you are in favor of requiring pharmacists to sell meds in violation of their personal principles, are you in favor of requiring teetotaling Baptist grocery store owners to sell beer, kosher butchers to sell pork chops, anti-gun sporting goods store owners to sell guns and bullets? Does a lefty bookstore owner have to sell Ann Coulter? Does a doc have to do abortions if she thinks it's immoral? I'm not referring to pharmacists who work in CVS or Walgreen's determining corporate policy for their work shifts; they clearly have to follow whatever the company policy is, but that policy might be not to carry this or that item. I'm referring to a pharmacist who owns his own store, decides whether to carry any individual item on his shelf. It's totally his right not to stock Plan B, or to sell it only to certain people (as long as he does not discriminate against protected groups).
This is an example of the concept that "your poor planning does not define my emergency."

At 9:05 PM, Blogger Dr. Andy said...

Sorry to take so long to reply. I keep getting error messages from Blogger. On my own blog!

I agree more medicines should be over the counter, but am not willing to go as far as saying nothing should be prescription. I do thing, say, Vicodin has public health implications.

I have no problems with individual pharmacies refusing to stock certain medicines (just as in the other examples you give). I do think it is reasonalbe for them to clearly communicate that info to consumers. What I do have a problem with is putatively full-service pharmacies which employ pharmacists who refuse to fill prescriptions

At 3:10 PM, Blogger HypnoKitten said...

I agree wholeheartedly with JB. The electrician comparison was right on track.

Isn't Vicodin OTC in Canada and Mexico?


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