From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Subject: Re: health care industry woes
Organization: Purdue University Statistics Department
Date: Mon, 23 Nov 1992 21:32:05 GMT

In article <1992Nov21.141539.22360@netcom.com> rkaplan@netcom.com (Richard Kaplan) writes:
>In article <1992Nov21.124934.29841@genie.slhs.udel.edu>
> starr@genie.slhs.udl.edu (Tim Starr) writes:

			...................

>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.  

The question has been raised (by others) whether the ban on thalidomide
did not do more harm than good.  The teratogenic effects could not have
been found except by using it on pregnant women; I understand that, in
rats, caffeine has a similar effect, but not thalidomide.  Even after
the teratogenic effects were found, was that any reason to prohibit 
thalidomide for those who are definitely not pregnant?  Retinoids, 
now allowed, are just as teratogenic as thalidomide.

>>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.

How does anyone know what drug is useful in a given situation?  It
is not the case that the doctor KNOWS.  The doctor guesses given the
available information.  What the doctor should do instead is to discuss
the alternatives with the patient, or if the patient is not competent
to make decisions, with someone with the appropriate power of attorney.

>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.

The doctor may or may not be qualified.  The doctor cannot be
considered to be objective.  I have seen many doctors; none of
them have seriously considered my value system.  It is my value
system which counts when I am being treated, unless the treatment
may directly harm others.

>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.  

See above.  The patient's representative should make the choice
in that case.
-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@snap.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!snap.stat!hrubin(UUCP)
Newsgroups: talk.politics.medicine