[In Italy] small proposals bring protesters to the streets, one hurdle to
making changes as protected interests seek to preserve themselves.
Pharmacists shut their doors this year when the government threatened
to allow supermarkets to sell aspirin. The cost for just 20 aspirin
tablets at a pharmacy is $5.75.
That is from an excellent article in the NYTimes on Italy’s malaise. We may snicker when we think that Italians couldn’t buy aspirin at the supermarket but our prescription-only system isn’t much better. Kerry Howley, writing in Reason, says Basta!
Aspirin is an excellent candidate if you want to bring something to Italy:
http://padovachronicles.welton.it/articles/2006/03/25/aspirin
It’s sad that the bureaucracy really is *that bad*:
http://padovachronicles.welton.it/articles/2007/08/18/confronting-the-bureaucratic-beast-registering-an-italian-domain
because the people are smart, hard working, very inventive, kind, and of course live in a beautiful place.
Thanks for the link, it’s a good read, and an accurate description of Italy’s problems at the moment.
The point isn’t that “our prescription-only system isn’t much better,” but rather that Europe may not actually be the health-care nirvana everyone wants to believe it is. It seems there is a side to the story never before considered. My goodness. If I could 30 cents a tablet on something a high-school kid can make in a chemistry lab, at sell it at much higher volumes than specialty prescription medications, I’d charge less for my other drugs too. Now I know the rest of the story. Thank you for this.
Prodi’s so-called “liberalization” of pharmaceuticals was designed to advantage the “Red” COOPs (communist cooperatives) which thanks to preferential treatment (tax-exemptions, political links to the left, mafia ties, etc…) have grown into a commercial empire and control most of the supermarket distribution. I’d be all for liberalizing access to markets if the communist capitalists that control Italy right now were held to the same standards as everybody else.
Rachel, statins have been available OTC in Great Britain for years.
http://news.bbc.co.uk/2/hi/health/3931157.stm
Rachel,
I’m on long term therapy with a hepatotoxic drug. I need liver function tests every 3 months. Know whose job it is to remember that and call the doctor? Mine. Know who has started every conversation I’ve had with the doctor about possible drug interactions, and who researches side effects? Me. All the points you make about drug risks are valid, but in the real world it’s not as though patients are getting all that from their doctors just because a drug is prescription-only. I realized a long time ago that I need to educate myself about my medications, and I go to a high-quality academic medical center for my care- my doctors have no lack of skill or knowledge. When we talk about alternatives, let’s not pretend the status quo is better than it actually is.
Alex: sorry for ignoring that natural experiment. I’m searching for followup articles on its progress in the UK, but not finding much- if anyone knows I’d be interested to hear. I’m more ok with the British “behind the counter” approach that at least can screen for pregnancy and comorbidity than I am with true OTC.
Nathan: I’m well aware that one must compare the benefits of both systems. My goal was to respond to what I consider omissions by Howley when she called statins “safe drugs” and expressed tacit agreement that doctors against OTC statins are “paternalistic.”
LisaMarie: I applaud your initiative, though I understand it is born of necessity. I admit I am influenced by the NIH environment and my lab in particular, which, I believe, is better than the average doctor’s office in terms of making sure most bases are covered for each patient.
The point I wanted to make, though, is that the pro-OTC contingent in the US is saying they want to help the poor and/or uninsured, who are probably less well-educated and less able to inform themselves than you are (forgive me if I have assumed too much about you). They are also sicker than the rich/insured. My experience with many of these patients at NIH is that they are not, in fact, capable of the level of self-care you demonstrate, much less self-diagnosis and self-medication.
Rachel,
That you disagree with an article does not necessarily render it “abysmally researched.” Are there factual errors you would like to address? If so, by all means let me know what they are so they can be noted at the end of the article.
The article is the product long conversations with doctors on the FDA advisory panel that recommended against OTC status. It is, in fact, extensively researched and reported. As articulated in the article, the panel’s major concerns were the inability of patients to self-diagnose and to comply with simple directions. And as with hormonal birth control, there was a sense that doctors needed to control access to the drugs in order to force patients to visit them regularly.
Several dissenting members of the panel felt that their voices were not being heard. The article was an attempt to flesh out their views and put them in historical context.
I’m heading to teach a semester in Rome 1/1/08, and high on my packing list is “250 count bottle of ibuprofen.” When I taught the same program in 2003 and had a flare up of carpal tunnel I could only buy NSAIDs in packages of 12 or 20. VERY unpleasant.
My wife feels very put upon by having her birth control being a prescription medicine. She fully understands the informational requirements and risks associated with ‘self-medication,’ but feels that she is part of the responsible majority penalized by inconvenience and cost because of an ignorant minority who would get themselves into trouble, then blame the government for not protecting them.
In my experience, every person I have known well enough to discuss such issues seems, like LisaMarie, to have done a fine job of educating themselves on drug matters. The basic question is whether or not the rules needed for ignorant people should be applied, at a cost and inconvenience to everyone.
Couldn’t we presume that someone with, say, a college degree is rational and knowledgeable enough to be exempt from the medical micromanagement, the way certain “sophisticated investors” are exempt from some of the nominal protections of certain securities laws?
Thanks Alex (and Kerry)- I try not to let internet anonymity turn me into a pompous jerk but it can be tempting. Both of you have been quite patient and amiable.
In Latinamerica aspirin is sold with prescription because dengue hemorragico( hemorragical) could be letal is people use aspirin to counter the symptoms of it.The person doesnt know and could not know she has dengue at the moment she began to feel headaches or fever
When anticonceptive drugs where ordered to be sold under prescription two of the three libertarian living in Venezuela acused the government they supported of surrender to chatolic churh pressure.
Antibiotic are sold under prescription in big chains drugstores.The independent drugstores will sell it to you under prescription and let you take the prescription with you and buy more
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