Glenn Greenwald doesn’t understand why patients need physician permission to obtain prescription drugs:
Adults have the right to do all sorts of things that other people, including experts in a particular field, think are stupid and self-destructive, even when the person’s livelihood or even life are at stake. That is, more or less, a defining attribute of being an adult.What is the difference between the attorney-client and doctor-patient relationship, where the former is purely advisory but the latter becomes parental? And other than consumption of medicine which can actually affect the public health (such as excessive consumption of antibiotics), why should an adult be deemed a criminal for using a particular medicine all because a doctor (for whatever reasons, including self-interest) will not give permission?
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{ 12 comments }
I read Salon on occasion, for entertainment. This is the first policy related piece that I recall agreeing with. I have had this discussion with friends on occasion- just because I have an MD, why do I have the authority to determine what others ingest? I can play with the dangerous electrical wires in my house or call a qualified electrician- my choice. I can break a leg fixing my roof, or call a competent roofing company- my choice. I can repair my car, and the wheel may fall off, or get a trained mechanic… What is the medical profession’s response to the charge that the Rx system is nothing more than a rent-seeking cartel? I also agree that antibiotics should remain controlled due to public health consideration, but why propranolol, why Mevacor?
This physician would personally prefer that patients who get angry at him for refusing to prescribe what is against his judgement would have the freedom to go get it themselves and leave him alone.
It doesn’t work very well where it is done however. In third world countries where self-prescribing is the rule rather than the exception, antibiotic resistance is more of a problem. People commonly self-prescribe psychotropics illegal though it is with dire results for them and for society, which expects itself to pick up the tab for the resulting disability. In practicality, the determined self-prescriber can get what they want. In theory it is a good libertarian idea. It doesn’t work out too well in practice.
Regarding the lawyer, in my state, the lawyers run the legislature and write the laws in such a way that it is, as a practical matter, impossible now to transfer property or engage in many other normal procedures of life without paying the lawyer bite.
The author and jb specifically exclude the drugs where self-prescribing would adversely affect other people’s health – antibiotics is one of the examples, narcotics and psychiatric drugs would probably be there as well.
But if the only person that ends up hurt is the patient himself, there really is no difference between allowing to self-prescribe and other risky behavior. And in some cases, the rules do seem to be over the board. Why is Renova wrinkle cream prescription-only when virtually any doctor, not even a dermatologist would say “sure” to any woman who asks for it anyway (and a zillion pharmacies in the internet would sell it with online doctor consultation)? A friend of mine gots Renova prescription from her dentist boyfriend. The package insert clearly explains its risks and side effects. Why 4% hydroquinone creams are prescription-only in the US (they are over the counter in Canada, I got Lustra from there myself)? These things are not covered by insurance anyway, so who is going to get hurt other than the person himself from using these drugs improperly?
I’m a genius, well educated, and a successful professional. But, I don’t know beans about medicine. I haven’t a clue which drug is best, or which one is to be avoided.
That’s why I visit my doctor and get a prescription, or not, depending on what he says. He knows; I don’t.
The Latin root for “doctor” means “teacher”. If doctors’ training engendered the attitude that their function is to educate a public that can then make well-informed choices, then I think letting people buy their own drugs without a script would be fine. But today’s medical environment gives little time to busy physician offices for teaching, which is unfortunate. Its my favorite part of being a physician.
Bruce, the thread is not as much about if it is a good idea to buy drugs without prescription – most will agree that it is not – as whether paople should be actively prevented from doing so if their actions do not harm anybody but themselves.
For example, if you don’t know much about mushrooms, it is a very bad idea for you to to buy a book and start gathering mushrooms and eating them. Yet there is no law that would prevent you from doing it without any “mushroom-gatherer” license. At least nobody asked me for this license last time I did it, and I’ve been doing it since I was 5, first – abroad, then – in the US:-).
This is the argument here.
I am kind of on the fence here. On the one hand, I don’t believe the government should have a right to dictate what we can do with our bodies as long as we are not harming anybody else. On the other hand, if you allow drugs (excluding those which present public health issues) to be sold without prescription, nothing would prevent people from giving them to their kids. So it is difficult to ensure in practice that anybody other than the person involved will be harmed.
BTW – my PCP had no clue what Renova was when I asked for it. He looked it up on the computer, asked me which dose I want, and gave it to me.
But your PCP studied biochemistry, physiology, pathology, and pharmacology and was prepared by background and experience to read a description a new drug, peruse the summary of the studies upon which it was released, and make a judgement as to whether he could rule out (based on chemical class, mechanism of action etc) any meaningful interference with your other conditions and meds, or whether more caution was indicated.
Unfortunately this is something that not only the general public is not equiped to do, but a great many of the ancillary personel now allowed to play doctor. Psychologist are given Px priveleges in two states–and they are university trained social scientists without any medical or natural science training except for the weekend courses to fullfill the RX requirements–requirements that they themselves wrote ( how would they know?).
In this return of pre-Flexnerian medicine, in which the state no longer protects the public from inadequately trained chalatans–and actually gives them liscenses–I would just as soon they take off all controls and leave it to a purely free market.
You don’t need physician permission–NP permission, PA permission, OD permission, PHD permission, DDS permission will all serve equally well in most places.
About the only liscensed professionals that can’t prescribe something in my state are lawyers, cosmetologists, and social workers. I don’t know why the state even bothers regulating it at all. They even liscense lay midwives here, yes, LAY midwives. That is silly. They are issuing a liscense certifying a complete lack of qualifications???
Don’t forget that, the law notwithstanding, there are plenty of whores on the internet who will RX anything–making RX laws a farce for those who wish to self-treat.
“What is the difference between the attorney-client and doctor-patient relationship, where the former is purely advisory but the latter becomes parental?”
Curious arguments from this lawyer. In reality, the legal system is substantially more opaque than medicine. The body of knowlege the comprises medicine is huge, constantly evolving, but has one constant, unchanging human physiology that must invariably follow the laws of physics, chemistry, biology. The law, by contrast is an ever changing confabulation of wills created not to be ultimately understood, but rather, to be misunderstood, to grant favor to some parties, and to be changed at the wims of the legal/legislative systems.
Reading lawyer sites suggests that most believe that representing one’s self is quite a folly, more so than I would consider treating one’s selfe medically for most conditions.
“What is the difference between the attorney-client and doctor-patient relationship, where the former is purely advisory but the latter becomes parental?”
Most lawyers do act parental with their recommendations, I think. They tell you their opinion for the best course of action and you take it. For example, how many people argue with their lawyers about handling tax audits? Probablynot many because the layperson using the lawyer doesn’t know enough about tax laws to make that decision, so they defer to the lawyer. Just the way most people defer to the judgment of a doctor.
This attorney is missing the point.
Perhaps the patient has a right to ask for certain classes of medications – but not opioids. Why? Simple. Because unless there is a legitimate pain condition, for which opioids are indicated, there would be no need to prescribe this class of medications.
The government has a legitimate purpose in limiting drug diversion. When a patient cannot be established as having a pain condition, he doesn’t need the medication; therefore, what is he going to do with it? Sell it? None of us know the answer.
But, as a pro-opioid pain specialist [ which everyone knows by now ] I cannot condone or allow illicit drug diversion – because that medication may fall into the hands of an innocent person who may die from an overdose.
This is unacceptable under the “First do no harm” rule.
The REAL question is; why does the state and federal government prosecute a pain specialist for prescribing in a legitimate fashion, based upon that doctors clinical impression that a patient requires, and would benefit from, opioid medication?
That’s the real issue these days.
William Mangino II, M.D.
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