From: rkaplan@netcom.com (Richard Kaplan)
Subject: Re: health care industry woes
Organization: Netcom - Online Communication Services  (408 241-9760 guest) 
Date: Sat, 21 Nov 1992 14:15:39 GMT

In article <1992Nov21.124934.29841@genie.slhs.udel.edu>
 starr@genie.slhs.udl.edu (Tim Starr) writes:


>Fraud is unlibertarian.  We have laws against it, and they should be strength-
>ened if they're inadequate to optimally minimize the offense.


Agreed 100%.


>However, licenses are no guarantee against fraud.  It's possible to defraud
>the agencies which grant the licenses, or to forge the licenses themselves.


Don't cut off your head (eliminate licenses) for a headache (fraud).
Your solution (delicensing) would create far more fraud.  You
already mentioned above the better solution.... strengthen the 
anti-fraud laws.


>There isn't any such surety that prescribed drugs are safe and effective,
>either.  AZT is fatal.  There are no long-term survivors of AIDS who are
>on it.  Yet it's prescribed for AIDS patients, isn't it?  If it hadn't been
>for bureaucratic delay, Thalidomide would have been marketed and damaged
>babies despite this ostensible guarantee.

AZT is not meant or promoted as curing AIDS..... In some patients,
it prolongs the remaining length of one's life.  Just like
many anti-cancer chemotherapy drugs.  

BTW, no drug (including over the counter medication) is completely
safe or completely effective.  All drugs fail at some times and
all drugs have risks.  This means we should manage the risks
properly and with the proper knowledge.

Your mention of Thalidomide shows PRECISELY why we should
not allow universal self-medication. The "bureacractic" delay
in the US when this medication was introduced came about 
because of the concerns of an FDA scientist that the drug
had not been proven safe enough.  England (which, like
much of the world, has signficantly more liberal drug marketing
laws) allowed the drug to be sold and we all know the
tragic results.  This, to me, is an argument FOR government
regulation of prescription drugs, not against it.  


>Furthermore, by what right are those who know what drug they need prohibited
>from buying it the same way they buy cars - through mutual consent with
>a seller to mutual benefit?  Why should any paternalistic authority have
>to be consulted?


How do you know which drug you need?  Often prescription drugs
by themselves are not particularly dangerous but the danger
comes in misdiagnosing yourself when you don't have access to
the necessary knowledge and equipment.  Granted, the current
system is not perfect and some prescription drugs could be made
OTC (e.g. recent conversion of Monistat to OTC status).
But the answer is absolutely not to blanketly make all drugs
legal and OTC.

One problem with legalizing drugs is that many drugs will 
alter one's thought process.  Therefore an objective (and
qualified) person is necessary to evaluate the efficacy
and appropriateness of the treatment.

Further, many patients who are ill cannot properly
make decisions, though they may not recognize this
themselves. So to allow a patient to self-diagnose and
self-medicate in an impaired state is dangerous.  

If you want, we can discuss SPECIFIC medications  which
should be converted to OTC.... there are lots of them.  But
certainly not ALL of them.


-- 
Richard Kaplan M.D.           Medical Software Exchange BBS
806 2nd St. SW # 104          (507) 281-1989 14,400 HST
Rochester, MN  55902          (507) 281-1689 Voice
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