That was a terrific podcast with intelligent discussion on interesting and important questions. As usual Dr. Prasad has the most succinct summary on the issue of doctor/hospital/patient relationships. "F**k the hospital". I think he speaks for many doctors with that statement. I am also glad to see someone tackle the issue of prescription requirement for medications. In my opinion, there should be no prescription requirement for any drug; they should be under the same regulation as alcohol---any adult can purchase whatever they wish. They may choose to consult a physician or not. There are a number of arguments against a free market in drugs and I will anticipate and try to briefly answer a couple here:
1. Without tight restrictions on drugs, the problems associated with drug use and abuse would be much worse. Really? We have had a "war on drugs" for the past 50 years or so. How has that been working out for us? Is there less abuse and addiction to drugs than we had 50 years ago? The primary effect has been to drive the price of drugs to levels that require criminal activity in order to afford drugs that literally only cost pennies to produce. The law abiding population then pays the price for that.
2. Without the drug laws the problem of fatalities due to drug overdose would become epidemic. This argument ignores the fact that most deaths from overdose most likely occur because there is no standardization of dose with illegal street drug sales. It is interesting that some of those who are most vociferous in proclaiming the tragedy of overdoses are also the most visible proponents of the regulations that prevent the drug users from knowing what is in the drugs they take. This is hypocrisy of the first order.
Great episode! Several questions leading to further contemplation on my part. The OTC status of more drugs is particularly interesting. Over the years, I have often thought that many drugs should be OTC as it takes time to write and monitor prescriptions so closely. I think in our current situation in medicine (ie, not enough PCP and doctors in general) some creative thinking as to how to potentially ease up some of the "busy work" required of physicians (as well as the "pain points" that hinder patients) is a good idea. Statins OTC really interesting. If it would help get rid of PBMs in any fashion, that would be a good thing. Perhaps having insurance companies cover the cost of OTC meds in the same degree they would cover it as a prescription. PPIs come to mind - they are widely available OTC but I still write for a LOT of prescriptions for them - doesn't seem to save much work on our end in that regard. It would seem so much more simple to advise a patient use an OTC med and then let them choose and buy exactly which one, and from then on they can quite easily keep themselves stocked with it. I don't know if insurers are getting better prices for certain PPI per a pharmaceutical company vs why not tell your patient pool to just purchase OTC (maybe have a particular Rx card that could be used, given to you by the insurer). This issue really does deserve more consideration on a broad scale.
Lilly selling Tirzepatide directly to the consumer is also an interesting phenomenon. Skip the insurer and the PBM completely.
Crap,I missed this. Currently it is 0914AM C.S.T. October 17, 2024. IF live podcast still ongoing AND not prior addressed, is there somewhere on Sensible Medicine that gives biostatistics 101 or idiot's guide to biostatistics. All three of you of course mention biostatistics over the years but I'm looking for didactic in one place or multiple consectutive posts. Thanks for all you three do!
How do I find the episode note? I’m sorry if this is a daft question, but I’m a bit of a luddite and have only just started using the Substack app. Thanks for a great podcast by the way!
“This podcast is one of three we will be posting to answer the questions that came to us in response to this post. We had a nice set of questions so we will certainly be doing it again.”
Hi. Have you had patients with orthostatic tachycardia and orthostatic hypotension, along with increasing in severity the other symptoms of autonomic dysautonomia? At the moment, no-one can tell me the reason for this.
Also have MGUS (IgG Lambda) generalised increasing neuropathy (awful pain in toes now) and haemochromatosis (C282Y) , for which I cannot always have venesection as anaemic. Investigations ongoing. This all started two weeks after second covid vaccination (AZ) in May 2021. Thanks for your time.
anyway you can do more posts on alternative medicines including such things as dmso and light therapy patches. As a pharmacist I find it frustrating with my current lack of faith in most “science”
studies now days to try to delineate objectively if something should be tried as a therapy.
Thank you for this episode. It was very helpful for a primary care physician!
That was a terrific podcast with intelligent discussion on interesting and important questions. As usual Dr. Prasad has the most succinct summary on the issue of doctor/hospital/patient relationships. "F**k the hospital". I think he speaks for many doctors with that statement. I am also glad to see someone tackle the issue of prescription requirement for medications. In my opinion, there should be no prescription requirement for any drug; they should be under the same regulation as alcohol---any adult can purchase whatever they wish. They may choose to consult a physician or not. There are a number of arguments against a free market in drugs and I will anticipate and try to briefly answer a couple here:
1. Without tight restrictions on drugs, the problems associated with drug use and abuse would be much worse. Really? We have had a "war on drugs" for the past 50 years or so. How has that been working out for us? Is there less abuse and addiction to drugs than we had 50 years ago? The primary effect has been to drive the price of drugs to levels that require criminal activity in order to afford drugs that literally only cost pennies to produce. The law abiding population then pays the price for that.
2. Without the drug laws the problem of fatalities due to drug overdose would become epidemic. This argument ignores the fact that most deaths from overdose most likely occur because there is no standardization of dose with illegal street drug sales. It is interesting that some of those who are most vociferous in proclaiming the tragedy of overdoses are also the most visible proponents of the regulations that prevent the drug users from knowing what is in the drugs they take. This is hypocrisy of the first order.
Exactly!
Antibiotics and asthma inhalers are OTC in many European and South American countries. Any information of negative effects?
Please take a look at the episode note.
Great episode! Several questions leading to further contemplation on my part. The OTC status of more drugs is particularly interesting. Over the years, I have often thought that many drugs should be OTC as it takes time to write and monitor prescriptions so closely. I think in our current situation in medicine (ie, not enough PCP and doctors in general) some creative thinking as to how to potentially ease up some of the "busy work" required of physicians (as well as the "pain points" that hinder patients) is a good idea. Statins OTC really interesting. If it would help get rid of PBMs in any fashion, that would be a good thing. Perhaps having insurance companies cover the cost of OTC meds in the same degree they would cover it as a prescription. PPIs come to mind - they are widely available OTC but I still write for a LOT of prescriptions for them - doesn't seem to save much work on our end in that regard. It would seem so much more simple to advise a patient use an OTC med and then let them choose and buy exactly which one, and from then on they can quite easily keep themselves stocked with it. I don't know if insurers are getting better prices for certain PPI per a pharmaceutical company vs why not tell your patient pool to just purchase OTC (maybe have a particular Rx card that could be used, given to you by the insurer). This issue really does deserve more consideration on a broad scale.
Lilly selling Tirzepatide directly to the consumer is also an interesting phenomenon. Skip the insurer and the PBM completely.
Crap,I missed this. Currently it is 0914AM C.S.T. October 17, 2024. IF live podcast still ongoing AND not prior addressed, is there somewhere on Sensible Medicine that gives biostatistics 101 or idiot's guide to biostatistics. All three of you of course mention biostatistics over the years but I'm looking for didactic in one place or multiple consectutive posts. Thanks for all you three do!
Please take a look at the episode note.
How do I find the episode note? I’m sorry if this is a daft question, but I’m a bit of a luddite and have only just started using the Substack app. Thanks for a great podcast by the way!
“This podcast is one of three we will be posting to answer the questions that came to us in response to this post. We had a nice set of questions so we will certainly be doing it again.”
Hi. Have you had patients with orthostatic tachycardia and orthostatic hypotension, along with increasing in severity the other symptoms of autonomic dysautonomia? At the moment, no-one can tell me the reason for this.
Also have MGUS (IgG Lambda) generalised increasing neuropathy (awful pain in toes now) and haemochromatosis (C282Y) , for which I cannot always have venesection as anaemic. Investigations ongoing. This all started two weeks after second covid vaccination (AZ) in May 2021. Thanks for your time.
Please take a look at the episode note.
Thank you for your reply, but where can I find the episode note? I know I am an English numpte, but I have looked everywhere. Eve
If I were to ask a question today, I would be inspired by the ARPA-H Sprint for Women's Health awardees.
Should we spend $3M of "moonshot" funding to study bacterial vaginosis? Or should that award have gone to something relating to women's heart disease?
anyway you can do more posts on alternative medicines including such things as dmso and light therapy patches. As a pharmacist I find it frustrating with my current lack of faith in most “science”
studies now days to try to delineate objectively if something should be tried as a therapy.