Prescriptions

[qatarperegrine]

Growing up in the States, I took it for granted that if you want practically any medicine more exotic than a baby aspirin, you have to have a note from your doctor saying you're allowed.

Then I moved to Qatar, where medical care is a bit more of a free-for-all. If I want birth control pills, I wander into the nearest pharmacy and grab some from the shelf, without my OB-GYN using it as leverage to get me in for an annual checkup. I can walk right into an optician and tell them I need some -3.75 diopter contact lenses and, by gum, they sell me -3.75 diopter contact lenses. If that's not what I needed, I have nobody to blame but myself. Hard-core things like opiates are by prescription only, but the rule of thumb is that if it's not at high risk of abuse or misuse, then you can probably waltz into a pharmacy and buy it.

I'm sure much thought is given to whether a product should be prescription or non-prescription in the States, but I realize I know very little about the justifications involved. What is the reasoning that says I can, at will, buy enough Tylenol to put me in a hepatic coma, but I need the permission of an optometrist to put pieces of silicone on my eyeballs?

Antibiotics seem like an interesting case here. They're not susceptible to abuse in the same sense as opiates, but certainly they can be misused, and their misuse can lead to drug-resistant bacteria. I'm particularly sensitive to the problems of letting people use antibiotics willy-nilly, since my last run-in with bacteria was with drug-resistant ones. On the other hand, right now I am having yet another run-in with bacteria, and I need antibiotics. I know I need them, there is no doubt that I need them, but I can't have them until I find a doctor to convince of this. Unfortunately the bacteria were inconsiderate enough to strike after 5 p.m., and thus the only doctors available are in the ER conveniently located across the street from my hotel. There are, however, around two dozen people waiting in said ER, and they all look sicker than me. So I get to wait until tomorrow morning (meanwhile hoping the bacteria don't decide to seek lebensraum in my kidneys) all so I can persuade somebody to let me have the medicine I already know I need.

I joke sometimes that living in a paternalistic state like Qatar is turning me into a libertarian. It's not really true. But right now, facing one of the few issues where the U.S. is more paternalistic than Qatar, I do resent needing the permission of someone I don't have access to in order to do what I know will make me better.

Comments

[qatar.livejournal.com]

lol. OK, you have a point there. (And it should be said that pharmacists in Doha do to some degree fulfill this role, although they don't do physical exams.)

I'm really thinking about this from more of a political philosophy angle, though. Certainly, prescription drug anarchy would not result in people being healthier, so it might fail the test of utilitarianism. But even John Stuart Mill thought that personal liberty trumps utility maximization. If I want to make a health decision that isn't in my own best interests, why shouldn't I be at liberty to do so? Is it really the government's place to save me from my own poor decisions?

Now antibiotics are a bad test case here, because my misusing antibiotics might have a harmful effect on society as a whole (although, so might the meat industry's misuse of antibiotics, and nobody's stopping them). But if we're talking about something like contact lenses or birth control pills, where nobody but me would be adversely affected by a poor decision, what right does the state have to stop me?

[kartiksg.livejournal.com]

Insurance money -- I though insurance was something silly people and foreigners had -- before I came to the states. Everyone I knew back home paid for their own healthcare.

[qatar.livejournal.com]

Ooh, you're right it'd be a waste of insurance money if people got medical care they didn't need. That would definitely give insurance companies the right to require prescriptions, in my book. But I don't see how it'd give the government the right.

And the lack of efficiency is part of what bothered me. I ended up going to the ER three times, which is ridiculously costly, and needing a lot more medication than I would have if I'd been able to buy some freaking Cipro the night we went to Orient Express.

[y-pestis.livejournal.com]

"If I want to make a health decision that isn't in my own best interests, why shouldn't I be at liberty to do so? Is it really the government's place to save me from my own poor decisions?"

You can't really say that having people see a doctor prevents them from making poor decisions. You know when you see a doctor and get antibiotics they do the plaintive "please take ALL of them, don't just stop when you feel better" because people do a half-course and then never finish. This is certainly a poor decision (assuming the need for antibiotics is valid in the first place). Similarly, there are people who see a doctor, find out they need a prescription, and never fill it, through laziness or budget constraints. And there are yet more, particularly in the US with no universal healthcare, who don't even have the opportunity to SEE a doctor due to budget constraints. And you certainly can't argue that THIS is in the best interests of the country.

When I worked at the vet diagnostic lab, I learned some interesting stuff about herd health. There's a somewhat different approach to medical care if you're dealing with a whole herd as opposed to individuals in isolation, because you want to avoid pandemics... you'd think the US would approach healthcare with a more herd-health attitude and try to treat everyone equally, for the good of the herd...