Why would a pharmaceutical manufacturer want to change a drug from prescription to over the counter (OTC)?
Well, one thing I’ve learned in my lifetime is – When the Question is “WHY?” then the answer is “MONEY.”
Oh, sure – in our economically-ignorant country, many people think – “Whee! I can buy any drug I want without spending money on a doctor’s appointment and without having to get a prescription! ”
These people are prime candidates for the Darwin Awards.
Yes, believe it or not, the “RX to OTC Switch” can actually HURT patients.
Drug patents expire relatively quickly, competitors are waiting at the gates with generic equivalents, and when a drug becomes OTC, there is a chance that insurance does not cover it.
This makes insurance companies and government programs (Medicare, Medicaid/Medi-Cal, etc.) very happy. They are so strapped for cash that even paying for a cheaper generic is a strain on the budget. When this kind of money is involved, you can bet that lobbyists are pressuring the government to ease their restrictions so that drugs once considered risky enough to warrant a prescription so that not just anybody can have access will be available to anyone who can walk into a drug store or click on a shopping cart on the web.
Patients will have to pay for OTC meds in cash money and doctors usually do not bother prescribing an equivalent drug. If they do not already know of an equivalent, they will probably — and generally do — just tell a patient to go buy it over the counter.
A patient who cannot afford the drug will go off it.
OK – so what’s the big deal if a cold medicine, allergy remedy or hair-restoring pill is no longer a prescription drug?
The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight. She later admitted to being 380 pounds. I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge. The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began. She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church. Moreover, he was a Sunday school teacher. You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint. But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial. This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.
There was a trial, and she had testified. She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window. By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over. She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty. She couldn’t. She had a panic attack as soon as she entered the courtroom. She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her. I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…
“Old Marley was as dead as a doornail.”
— A Christmas Carol (1843)
Thank you, Charles Dickens, for creating such a wonderful, enduring story, and such an apt simile. If you hadn’t heard it before, that’s probably because it is usually omitted from the children’s versions of the oft-told (and filmed and broadcast) tale. With everyone from Michael Caine to (my favorite) Mr. Magoo starring as the wickedest man who ever snorted “Bah Humbug!” and was converted to the most ardent celebrant of Christmas by the end of the story.
A wonderful, happy story — and it deserves to live forever. But death is not terribly suitable material with which to start a children’s story.
Young women (and men) — some no older than children and many who could be termed “recent children” — were ardent fans of singer Amy Winehouse — who is now “dead as a doornail.” Read more on Amy Winehouse Proved Drugs Aren’t Glamorous…
I think everybody loves to eat. Eating can be pure, sensual delight. And those that don’t like eating – well, they come see somebody like me because that can be a real problem. It can be a problem for those that REALLY love to eat also – like the 700 lb. woman that not only makes her living in eating contests, but wants to be a record holding “Most Obese Woman” in the world.
I’ve seen some patients who could be in the running for this. Sometimes they have medical treatment to blame. Many medicines can add weight even if you eat nothing but air and water – seriously. I have seen people gain weight regularly, usually 15 to 20 pounds a month or so. Steroids, psychotropics and some other drugs can make you gain weight and keep you losing weight. Even treatments for diabetes – like insulin. Read more on Will Your Doctor Help You Lose Weight? Fat Chance!…
I’m nowhere near what anyone would call a “News Junkie.” My husband, a former newspaper man, often calls my attention to articles of interest and I see headlines occasionally on various web pages, such as Yahoo or Google. But this type of story seems to come up pretty regularly any more.
Yes, most people in our country are in terrible shape. I probably harp about it more than I need to. But remember what Mark Twain (another newspaper man) once said:
“Everybody talks about the weather, but nobody does anything about it!” Read more on Who Needs Wonder Drugs? We Have Vitamin C!…
Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers. He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.
The first class of drugs I think about, when I think of sudden death, are the stimulants. I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first. Doctors asked a lot of questions about chest pain, and administered an electrocardiogram. These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight. He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…
Have you ever felt that your doctor just isn’t listening to you?Now multiply that by a hundred and you will start to understand what happens when a mentally ill person has a serious physical illness.
A news story on a recent study about how patients with a psychiatric diagnosis are prioritized at the bottom of the list when presenting at an emergency room induced a flashback when I was a young and eager resident psychiatrist on ER duty.
I was dedicated and enthusiastic – some said idealistic – and proud of knowledge obtained not without difficulty. The event I recalled was a 39-year-old schizophrenic man coming in with chest pain and trouble breathing. Maybe he seemed a little young for a heart attack, but gasping for air, clutching his chest and crying with pain. Serious complaints that ought to be treated seriously until proven otherwise. Read more on Mentally Ill Have Low Priority In Emergencies…
I know some people think I’m not a sports fan – and I’m really not – and that’s why I harp on the negative side of sports news.
But the truth is that I’m a humanist and a doctor, and I continually wonder why our society is so dedicated to dangerous and destructive activities that – if they were not so profitable and so glamorized – should be considered insanity.
Every time a person – especially young people – dies during an athletic contest or practice, every time there is a tragic injury or accident while “playing games” I shudder.
Somebody died at a triathlon, and somebody else had something wrong.
Of course, the uneducated and, generally speaking, minimally-informed people who comment on such things say they think it must have been something in the water.
When I was a very junior neurosurgical resident in France, I always thanked my lucky stars I had not overused coffee. Mme. M., who ran the cafe below my apartment throughout the first part of my studies, which were mostly classroom, had an Italian espresso machine and little demitasses (half-cups) of potent brew — so potent that I could not consume more than one in the morning. Arabica, fragrant, and aromatic, it was a true joy.
After I moved closer to the hospital center, I heard for the first time the expression “pump yourself full of coffee.” (se pomper pleine de cafe) It was foul tasting stuff, consumed in an infinity of Styrofoam cups, and strong — really strong. There were rumors that it came from the same “common market supplier” as the wine, which was supposed to also be from a a mixture of common market (it had not yet become the European Union) countries. All the food was free, as we were government employees.
Nobody ever figured out where the coffee had come from.
There was an open bar 24/7, about as well outfitted as Mme. M’s. I was afraid to be in the same room with it. I am delighted to report that I never saw anyone use it on an on-call night.
This is the place I could access a small bed — iron tubes for headboard and rails, mattress probably stiffened with starch. The joke, which may well have been true, was that it was Napoleonic non-issue, meant for a barracks.
After the first night I lay upon it sleepless, answering a beeper that whenever it rang told me to call the operator and they would tell me who to call, my then-young back was killing me and I was fighting tears. Read more on Save Lives — Let Doctors Sleep!…