JP at Large: The more we go forward, the behinder we get

October 8, 2007

Pharmacists as licensed prescribers.

What a remarkably forward-looking idea. Pharmacists are perfectly capable to assist in the streamlining of the system, helping patients in need get the appropriate medications. However, you know and I know that the American Medical Association will hesitate to give up that kind of power. That organization of physicians even put up a fuss about Plan B being sold at the discretion of pharmacists. With AMA, it is all about power.

The old guard of doctors is having conniption fits all over the place because the young physicians out there are allowing the medical pyramid to be flattened. Docs are still at the apex, but the drop down to the foundation is not that far anymore.

"Is there a price difference?"

"You betcha," I said. I gave him the figures.

"That much?"

"Can I change it?"

"Of course you can. Why are you even calling me? There can't be any therapeutic difference. It's OK with me if you change something like that."

"Ah, we're not there yet, doctor." He will learn. He is young. They'll beat some elitism into him whether he likes it or not.

"You can just call my nurse. Have her change the chart."

Ah, what an idea that is.

In the late 1960s, I had a doctor in California work me over because I suggested that his patient avoid dairy products while taking tetracycline. He had written take with food on the prescription. I had to mail a package insert, suitably highlighted, to him before he got off my back. In 2007, it is very clear that patients benefit with the entire medical team in the loop.

Double gadzooks! A class of Rx-only drugs that can be refilled at the pharmacist's discretion? The modern thinker in 1964 was the executive director of the American Pharmaceutical Association, William S. Apple.

What do I have to say about Apple? Where is he when we really need him? The medical establishment is about ready to break or fall apart, if we continue to put the load of final decision-making on the shoulders of physicians who cannot even be trusted to call back in a timely manner when there is need of their definitive word on a prescription. People go without because prescribers are just too loaded down with work.

It is distressing to me that a fourth class of drugs giving pharmacists more power was suggested in 1964 when we can't even get an extended third class. Septra DS (sulfamethoxazole/trimethoprim, Monarch Pharmaceuticals) for urinary tract infections would fit well. There is some good news, though. The FDA commissioner, Andrew von Eschenbach, has come out in favor of a third class of drugs. Our leaders should be on this with both feet.

We are in the 21st century. How could we be getting behind?