Medscape Medical News
Pharmacists Dispensing Without Rx 'Scary,' Say Med Societies
May 2, 2012 — Imagine a patient walking into a pharmacy, self-diagnosing a cough at a kiosk with medical software, and then getting a drug from a pharmacist in the back of the store, all without a physician's prescription.
The US Food and Drug Administration (FDA) is imagining this scenario, much to the alarm of the American Medical Association (AMA) and other medical societies, which see the beginnings of an end-run around physician authority.
Sandra Fryhofer, MD, chair-elect of the AMA Council on Science and Public Health, said her group continues to "strongly support" the status quo of 2 drug classes — prescription and traditional OTC. In exploring how new technologies and new roles for pharmacists might expand the portfolio of OTC drugs, the FDA should not "undermine the relationship that a patient has with his or her physician."
"In our view, lack of oversight from a practitioner could be a serious concern," said Dr. Fryhofer.
The FDA has not provided any evidence showing that patients with hypertension, hyperlipidemia, or asthma can diagnose and manage these conditions by themselves, she noted. "The balance of medical evidence strongly suggests otherwise." She also estimated that patients would pay more out-of-pocket for drugs that insurers would shift into the OTC safe-use category.
Bobby Lanier, MD, speaking for the American College of Allergy, Asthma and Immunology (ACAAI), raised similar concerns, but more pointedly.
"The new proposals here being discussed are chilling and scary," said Dr. Lanier. "You are facilitating bad behavior by not having (patients) talk to a clinician. In our mind, there is no substitute for a clinician."
Which brings to mind the fact that when the FDA decided to move painkillers and allergy meds OTC, you heard the same dire warnings. Now the same groups are seeking to change an Obamacare law requiring a doctor's prescription for OTC drugs purchased through a Flexible Spending Account. Not necessary and too much of a hassle according to the AMA and other medical lobbies. In Dr. Lanier's words, it's ok to facilitate bad behavior with existing OTC products but not new ones.
The FDA should be commended for promoting more consumer-driven care. As Peter and I demonstrated in our recent survey on cough medicine usage, the vast majority of Americans like OTC access because it makes health care simpler and therefore more likely. Doctors are behind the curve on the consumer revolution. Rather than trying to derail it, doctors should embrace new ways of connecting with patients and finding ways to help consumers help themselves. http://cmpi.org/uploads/File/CMPI_CoughSurvey_KeyFindings.pdf