Fri, Aug

News We Can Use: Drugs That Are, Should, or Might Be Over the Counter

BIG PHARMA POLITICS--Nothing in life is free, but too often things are more expensive for all of us, and make our lives more difficult because of that expense.

So, while it's to be argued that NOTHING in life should be FREE (unless it's provided by volunteers), the cost of medications is particularly problematic ... with most of them too darned high in cost. 

And nothing is going up in cost like that of medications, with really nothing except investor and corporate profits being valued over the health and survival of Americans. 

Sadly, both the President and the Speaker of the House were nearing a deal on lowering drug costs, but their political warfare threatens to kill that deal until the next election cycle or beyond. However, their aides are talking.

I'll go out on a short limb and suggest that the average American cares a LOT more about medication costs than anything going on in Ukraine, Syria, or China (not that those areas and issues are important, but...priorities, right?).

There's the quasi-socialist approach (price caps, tying the cost of drugs for American consumers, particularly Medicare patients, to European and Canadian consumers who pay 1/2 to 1/3 the cost for the same medications). That might work.

There's the "capitalist" approach of expanding generic competition which has also been shown to work. Probably a bit of socialism and capitalism are needed to get the right results.

And, in case you're wondering, doctors and other providers are freaked out as much as their patients. Nothing makes sense anymore when a provider writes for what is believed to be the cheap generic only to get an angry phone call from a patient for a $200 medication that used to be $25 only 1-2 months ago (and has been around for 40 years or more).

So enter the Sacramento law to allow Californians to get a two month supply of HIV prevention pills (otherwise known as PrEP) without a prescription. 

There are side effects and potential problems with taking PrEP, but the possibility of preventing HIV-negative patients from getting HIV is just too important to ignore. So...is this is a good idea, or a problematic idea with good intentions?

By the way, STDs (sexually-transmitted diseases) are going up, and a sharp rise of babies born with syphilis is occurring as well. One need not be a physician to conclude that this is very BAD.

I've seen physician assistants, nurse practitioners, and both pharmacists and their techs go "rogue" and that's a big problem. I've ALSO seen sharp, closely monitored, and well-organized teams of physician extenders and pharmacy staff work together to make cheaper, more accessible health care in some amazing ways. I've got a nurse practitioner and physician assistant who are first-rate!

So, the need to make health care more cost-effective, accessible, and efficient is one (if not the most important) big priority of physicians today if they want to lead health care into the 21st Century.

Just as RN's have moved beyond just being clinic nurses to administrators and providers of health care, so as well must doctors (both MDs and DOs) adjust.

Organizing for over-the-counter (OTC) treatments and emphasizing evidence-based medicine is one thing that doctors can do.

Did you know that health plans and doctors worked together to allow non-sedating antihistamines to be OTC? Hence, we have Claritin, Allegra, and Zyrtec OTC. 

Did you know that Plan B (pregnancy prevention when "things happen too fast" or when condoms break) is OTC?

The debate over whether birth control should be OTC is still fierce, with many OB-Gyns opposed to that. It is my belief they should be OTC but ONLY with either a trained pharmacist or a trained physician extender able to counsel patients on this medication (strokes and blood clots and breast cancer issues aren't to be taken likely).

But SOMETHING needs to be done in a world where both Plan B and birth control should be easy to obtain and educate the public about.

In the dermatology world, when Differin Gel became OTC things were excellent--that topical retinoid is now $15-30 and used to be only available by prescription for $150 or more. Probably Retin-A should ALSO be OTC, but as with Differin both should NOT be taken when pregnant (their chemical nature is like Accutane, which can lead to birth defects when taken by pregnant women).

And, as with OTC benzoyl peroxide, another staple of acne treatment, Differin can cause irritation of the skin--hence a warning from the pharmacist or trained pharmacy tech is needed. But a doctor visit? Maybe a great idea, but certainly for experienced acne patients it's not always necessary.

The need to be innovative and smart (and with a healthy dose of common sense) for cost-effective, affordable and accessible health care is as necessary as ever. Americans are being bled dry, and unnecessarily so.

But for those who claim to be patient advocates, the battle is both virtuous, imperative, and absolutely winnable.


(CityWatch Columnist, Kenneth S. Alpern, M.D, is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud husband and father to two cherished children and a wonderful wife. He was (termed out) also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Outreach Committee, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee and Vice-Chair of its Planning Committee. He was co-chair of the CD11 Transportation Advisory Committee and chaired the nonprofit Transit Coalition and can be reached at Ken.Alpern@MarVista.org. He also co-chairs the grassroots Friends of the Green Line at www.fogl.us. The views expressed in this article are solely those of Dr. Alpern.)