Bloodless Coup

That's brutal. Any notion of what part of the country this was? I'm guessing there is regional variation...

Ohio, which given a lot of the recent legislation coming out of there/being considered there (e.g. the pregnant adult women can't cross state lines for an abortion, the in vitro only for married people, etc) seems to be the Reduce Women's Rights State.

I'm fast coming to think that basically the whole prescription system should be thrown out.

Who's with me for a free market! (B/c sadly I don't see any other way around nosy idiots like these.)

I've lived in two countries where the only things restricted were opiates, and, um, well, opiates. On the one hand, I really appreciated the ability to go in and get what I needed right away, especially for routine diagnoses (Ay que cosa! Fue nadando en el mar sucio! Necessitas la medicina del ojo!). On the other hand, had I an allergic reaction, and no doctor (only the pharmacist) well...

The "no doctor" problem would not have to be limiting. After all, having no prescriptions doesn't mean you can't go to a doctor to get a specific recommendation (and they'll know what you are on). It just means we get rid of prescriptions. I'm certainly in favor of that; what do they accomplish? What did they accomplish?

Well, I was thinking of the case where someone is too poor to afford the doctor, but can go to a pharmacy and get drugs. What happens in the case of complications? In other countries, with public health care, that wouldn't be as big a deal as it would here.

I'm not sure a poor person would be worse off than the present system. If they need drugs today, they go to a doctor (which they can't afford), or the emergency room (which raises rates for everyone). Allowing them to buy direct from the pharmacy might result in drug interactions/complications, but the poor are no more likely to encounter that problem than the rich. And they can still go to the emergency room.

If they can get there (I'm thinking towns with a CVS but no hospital).

The prescription system is one of many things (but a biggie) that has contributed to the infantilization of American society. I'm all for getting rid of it, or at least cutting it waaaaaaaay back (like, to opiates and maybe things with deeply scary side effects and things you really ought to be in a hospital to be receiving.)

As to Baltar's first comment, there sure as heck is regional variation. If something like this happened in Massachusetts it'd be front page news and the doctor in question would be hounded out of business.

One more but... more power to pharmacists, who seem to be on the front lines for attack by fundamantalists, the same way school boards were a few years ago.

first, this story really is appalling, and alas, while i imagine pittsburgh itself is probably better, i also imagine that the western 3/4 of the state, and some of its easternmost portion, are much the same. the OTC alternative will make things better, one hopes, but i still foresee a run-in with certain remote pharmacies that will claim scruples and not carry it).

baltar, you write:

Allowing them to buy direct from the pharmacy might result in drug interactions/complications, but the poor are no more likely to encounter that problem than the rich. And they can still go to the emergency room.

I disagree quite a bit with you're suggestion that the poor and the rich are equally likely to make disastrous pharmaceutical decisions left to their own devices. There's an education gap there, and the rich will, when in doubt, tend to see doctors (and in an OTC world, doctors would probably do more recommending in this regard over the phone as well, making it easier to get advice). Literacy, basic reading comprehension, is divergent between the poor and wealthy, and even if both groups, by and large, tried their hardest to read warnings regarding interactions, allergies, and interrelated conditions, the more educated would more likely make wise decisions than the poor.

Also note, that under the current heavily regulated regime, marketing runs roughshod over the truth. Making all or most pharmaceuticals OTC would render somewhat illogical the heavy limitations on TV advertising for pharmaceuticals, and even if the regulations persisted, the power of that advertising to move the market would increase by an order of magnitude. Everyone knows that Coke is an alternative to Pepsi, that Chevy is less expensive than Toyota by and large, but who knows whether Claritin barely outperforms a placebo, or that effexor is just celexa reengineered. And who's going to tell everyone in ways they understand.

Also consider, that if no scrip is necessary to secure whatever medication, why would insurers take one's word for it that the medication in question is what you need. Once again, the income disparity comes into play in material ways.

I'm no huge fan of the regime as it exists, but I'm just not that categorically opposed to this aspect of the nanny state given that the above contingencies represent consequences of the alternatives.

effexor isn't reengineered, celexa. i think reengineered celexa is lexapro. in any event, the point remains.

Well I'm not opposed to the world still having pharmacists, or doctors for that matter. Obviously going to them will help individuals make proper medical choices. And the insurance question is a problem (as it is in oh so many ways), no doubt.

But it's the nanny state business and the infantilization thing that really gets to me. If I know I need a drug I find it absurd and not at all "freedom-respecting" that I can't get that drug on my own b/c of a medical lobby spreading around big bucks to maintain its influence, or the majority vote of some poorly informed state legislature.

As an ideological matter I'm generally in favor of being allowed to buy what you want to buy - and you can turn up the intensity of that 5 times or 180 fold when you talk about things you NEED to buy to live. People need to have some liberty in this world (isn't that what the president is always yammering about?) and be able to make responsible choices for themselves, irrespective of what Rev. Sheldon, Gladys Kravitz or the medical lobbies think.

Moon, I'll certainly grant that income levels are correlated with both education and access to modern medicine. Freeing up the presciption drug system will (almost certainly) result in more drug reaction/overdose cases. The large (public policy) question is whether the harm is outweighted by the benefits: all those (rich and poor) people who do have enough knowledge/information to be able to get their drugs without paying the cost of going through a doctor. I'm not convinved the positives outweight the negatives, but I'm at least willing to consider it.

As for advertising, I'm tempted to argue that anyone that makes a drug choice based on TV/Print/radio adds deserves what they get. That would be callous, of me, however. I'll merely note that, like many forms of free speech, advertising has a significant negative component. It is (mostly) a free society, and having consumer "smarts" is just as necessary in the grocery store as it would be in the hypothetical prescription-free pharmacy. More so, because the drugs are more dangerous. That inherent danger, however, isn't necessarily relevant to ethical or rights-based arguements about freedom to buy/freedom to make mistakes. We allow cars, and they kill 50,000+ a year. What's the difference?

the difference between cars and drugs is that you don't need an M.D., a Ph.D., or a PDR to learn that you want to push the pedal on the left when approaching a dangerous intersection.

i find myself uncomfortable defending a nanny state or any number of layers of public and private bureaucracy, given my generally libertarian leanings, but i just can't see myself past the system breaking down absent something like it's current form. the current system spreads liability around quite nicely. the alternative, realistically and given the general framework of American tort law, would deposit most of the liability with the manufacturers and retailers of medications, and the manufacturers would probably be able to insulate themselves pretty well with their retail agreements. the result would be that no one would carry really dangerous drugs except at prices so exorbitant they would make current pricing abominations seem tame.

who is going to retail anti-seizure medications? chemotherapy? HIV therapy? anything with potentially lethal side effects? and is each patient going to have to go to court to get an order finding that a patient needs a given medication and his insurance company must pay?

there are much more complex public health implications in the pharmaceutical realm than in the driving realm. and even given that, it's worth noting that driving is hardly unregulated. on the above rationales, why should i have to get a license, be beyond a certain age, pass your stupid test, drive by a particular speed limit, inspect my car, maintain functioning brakes, insure myself, etc.? why should my constitutional privacy interests in my car be substantially diminished relative to those i enjoy in my home?

libertarian though i may tend, i favor something in the ballpark of socialized medicine. the current system is awful in so many ways, but many of the pieces of a good system are already in place, and i wouldn't throw the baby out with the bathwater. i think pervasive deregulation of pharmaceuticals and the like would have a regressive effect on mortality, access, etc. isn't there already enough of that?

OK - well how about no scripts for things that aren't "really dangerous drugs"? I mean geez you can't even get psuedophedrine in tylenol any more.

I read a story about Celexa years ago. IIRC, they synthesized a molecule which had good therapeutic effects. They then synthesized a mirror-image molecule, which was benign but ineffective, and attached the two. That's Celexa. When Celexa's patents were expiring, they lopped off the mirror-image and claimed "new and improved". Boom, Lexapro. And remarkably, Lexapro has the SAME EFFECT as Celexa -- with half the dosage!

Apparently this is a not-uncommon practice in the pharma biz.

isn't the sudafed / tylenol thing something to do with crystal meth manufacture? if tylenol sinus no longer exists, it's news to me.

as for the whole celexa / lexapro thing, yeah, that's it, and it's typical of big pharma. to be clear, i've got no lover for big pharma. i just have no illusions about the creativity people employ in hurting themselves, and while part of me is inclined to leave it to the darwin awards, part of me thinks this is a very dangerous place we live in now, in ways that require far more sophistication than historic dangers have required, and leaving individuals to fend for themselves against the prevarications of big corporations seems a smite unfair. especially if the demographic we're talking about has to work 60 hours a week just to put a roof over their familes' heads. that doesn't leave much time for surfing the web to learn what is and isn't dangerous.

Yes. Where my folks live they have a HUGE problem with meth, and you have to ask the pharmacist for sudafed, and even then they will only sell you two packages (max) and you have to give your name and address.

wow. it's nothing like that up here. i knew it was different in the areas where the problem has been more prevalent, but i had no idea it had gone that far.

speaking of which, if we deregulate even just the so-called safer pharmaceuticals, how long til some chemist figures out how to mess around with them in a way that creates a whole new family of dangerous recreational drug? one more strike against OTC'ing everything.

And update from Biting Beaver. She gets mail.