By Rod Moser, PA, PhD
When you think about it, the vast majority of human afflictions are diagnosed and cared for at home. You get a minor headache, you self-prescribe some acetaminophen or ibuprofen. When your little one falls and hits his head, you kiss it to make it better. In a typical month, you may put band-aids on boo-boos, Neosporin on cuts, hydrocortisone cream on an itchy rash. You make decisions every day as to when, or if, you will see a medical provider.
There is a growing trend to not only allow, but encourage, people to take a more active role in their medical care. It is certainly less expensive. The Food and Drug Administration (FDA) is considering waiving prescription requirements for certain drugs used to treat asthma, migraines, and even diabetes. Touch-screen computers are showing up in pharmacies to help patients navigate their symptoms to come up with diagnostic possibilities. WebMD has had that on-line for many years now.
A hundred years ago, you could buy cocaine-containing medicines without a doctor’s prescription. One use of cocaine was for teething in babies! Diarrhea was treated with paregoric (tincture of opium) in my youth, but I believe by that time (the 1950s), it was already being controlled. In the Old West, cowboys could go to the mercantile store and buy laudanum (morphine/opium) over the counter. Even the original Coca-Cola had some cocaine in it (later switched to caffeine).
Eventually, prescription authority came to be a carefully guarded privilege granted solely to physicians and dentists, but over the last few decades that privilege has been extended to physician assistants, expanded role or advance-practice nurses (nurse practitioners), optometrists, and other health care professionals. I personally feel that pharmacists should be able to prescribe certain medications. Psychologists and chiropractors cannot prescribe medications, but both professions are pushing the regulatory agencies to do so.
At the same time that prescription authority has been expanded, more and more formerly prescription medications have gone “over-the-counter”. Examples are allergy medications like Claritin, Zyrtec, and Allegra. Monistat vaginal cream was once available only by prescription, so women had to pay big bucks to treat a yeast infection. Now, they can self-diagnose and treat them safely at home. Tagamet, Zantac, and other drugs in this class have been released. I remember a time when ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) required a prescription.
So, the United States went from allowing the free distribution of many dangerous and addictive drugs, to tight controls, to less-tight controls. But just because the FDA is loosening their regulatory grip on many drugs does not mean you may someday be able to buy codeine or cocaine at the 7-11.
I have not seen the list of proposed drugs that are being considered for over-the-counter release, but I am skeptical of inhaled asthma drugs, like albuterol. If a person could self-prescribe albuterol, their asthma could quickly get out of control. The mainstay of asthma management requires more than just this common bronchodilator. If you are using a lot of albuterol, you are NOT in control.
Diabetics should be able to buy insulin and diabetic supplies (needles, syringes, and test strips) without a prescription. I believe that a few states already allow this. I am curious about the migraine medications. I have found over the years that people who come up with a diagnosis of migraines often do not have migraines at all but rather muscle tension headaches. They self-diagnosed their headaches as migraines, thinking that the word, “migraine,” just means “very bad headaches.”
People can, and should, take a more active role in their own and family’s medical care, but to do so requires that you tread carefully when you make that all-important self-diagnosis. I would not want to hear about a patient treating themselves for migraines, only to find later that they have a brain tumor or aneurysm. Or, that painful yeast infection turns out to be herpes or other sexually-transmitted disease. It’s okay to be your own doctor sometimes, but sometimes you need to the help of a medical professional.
How do you feel about self-diagnosis and self-treatment? Is it getting out of control, or should you have more of a say? Share your thoughts in the comments below, and join Dr. Moser in regular discussions in our Ear, Nose, and Throat community.