Originally published on StudentDoctor.net

Throughout most of the world, patients are free to obtain medications over the counter (OTC) without the mandatory intermediacy of a physician. Why is it then that patients in the United States are compelled to see a doctor to get a prescription drug?

Some doctors (and their associations and medical boards) will say that this control over patients is “for their own good, as the patients could hurt themselves otherwise.” By so arguing to maintain this legal control over each individual’s opportunities and behaviors, doctors rely on compulsion of their patients instead of a more noble form of convincing, such as education, advice, and caring persuasion.

Here is a dirty secret: pharmaceutical companies are the primary beneficiaries of the prescription system we have in the United States and their welfare is the primary reason why it exists. Their profit margins are irrationally higher than they should be if they were subject to free-market discipline of consumer-level competition. When the patient gets to the pharmacy he has no opportunity to choose among multiple different appropriate drugs that should be competing for his business, and so cannot choose the one that provides for him the best combination of price and quality. This lack of grass roots, patient-level price competition, conspiring with the moral hazard of third party payers covering many pharmaceutical costs, result in a disruption that prevents market forces from keeping prices appropriately low. I never understand why so many people want government to hinder the free market’s ability to help us.

How many people have suffered from delayed therapy because they cannot afford the money or time to go to the doctor, but could have stopped by Walmart to pick up a nasal steroid to help their allergies? How many allergy sufferers will now have a chance to buy Nasacort (a nasal steroid now FINALLY over the counter!) at cheap prices and no risk, and which for most patients is a much better medication for allergic rhinitis than any antihistamine?

Why does it take so long for Prilosec, Prevacid, Allegra, Claritin, Zyrtec and others to go OTC? After all, they are very safe medications! It is because of our prescription mandates and health insurance system and the protections those systems provide, not to the patients, but rather to the pharma companies!

What of this issue of safety? Will there be danger? Certainly. But the current danger of the prescription system is fully evident: economic inefficiency with resulting poor access to therapies, and loss of liberty. Will the danger of freer access to prescriptions be greater than the danger of the current system?

With wastage of resources into bureaucratic overhead spawned by government intrusion into health care, doctors have less and less time to educate their patients. However, education about the benefits and risks of medications is abundant and available from the Internet, and of course the pharmacists. Certainly it would remain wise for many patients to get advice from professionals. They could and often would still choose to see their doctor. But if the drugs were OTC, the patients would not be compelled to see their doctor. Eager American entrepreneurs hoping for a resurgence of some free market in health care would gravitate rapidly to serve the diagnostic, safety, advisory and educational needs of people who would choose to occasionally bypass the hassles of going to the doctor. Exciting new flexible health care provision models will be created by the wonders of the free market, if the nanny-state got out of our way.

Americans are not stupid. Some drugs are toxic. They will be labeled as such. Some drugs require careful dosing. Americans can measure and count. Our government schools haven’t failed them to that extent. American individuals and drug manufacturers can and do figure out how to assure medications are taken safely. They will do it even better without the liability wall between manufacturer and patient that is provided by the doctor’s prescription pad. The market and the Internet will conspire fruitfully to improve the patients’ knowledge and therefore their safety. Pharmacists and doctors and nurses will all be available to provide advice whenever the patient wants. An elimination of the need for most prescriptions will put the pharmacist in the position of using their training not for filling out forms and calling insurance companies, but for providing health care and education.

Patients increasingly are obtaining health care without doctors. They can measure their own cholesterol now without a doctor, and do many other medical diagnostic processes, and more power to them! Learning what a cholesterol level means requires only a quick trip down Internet lane. In fact, from the Internet, patients can have more up to date information than their doctors have, and the Internet will spend more time teaching them than the doctors and pharmacist now ever can. The patient can then choose the best value for his money, spending it on medication, or choosing other interventions. Some people need more advice than others, but that should be up to them to determine, not the government. Let’s make expert help as available and cheap as possible. Mandating consumption of expert help achieves neither of those goals.

Are we so high and mighty as a profession that we feel we have the right to legally prevent our patients from exercising their own judgment? Are we so narcissistic to think we have the right to demand they come and seek the advice of our brilliant and omniscient selves before they treat their diseases or maintain their health with modern medication? Or is it that we have so little confidence in our value to our patients that we fear losing “business” if the patients aren’t compelled to see us? The answer is clear: we as a profession are paternalistically protecting the patients, even when it is against their will. This attitude is elitist and anything but humble. The fact that we physicians have received extensive education gives us the right to serve as valuable advisers, but not the right to be autocratic dictators.

The prescription mandate is a mess; it is a US, not global, mess. It is part of the crony-corporatist system that is health care in the US, overseen by an FDA that serves big pharma’s monopoly desires. Prescriptions serve special interests (doctors and pharmaceutical companies) but not the patient (who could of course still voluntarily seek wise counsel from their doctor!).

Consider this proposal:

1) The default for medications should be over-the-counter.

2) Prescriptions can be required by the pharmaceutical company selling the medication if they think it is necessary, and the prescription requirement enforced by the company through standard contract law, not by a crony-government agency.

3) Patients can readily choose among the many options that would become available to them, thus keeping the prices down. And they can always seek advice from their doctor.

Special consideration would need to be considered for antibiotics because if a patient takes an antibiotic improperly, it adversely affects other patients through the development of microbial resistance. Likewise because of the political brouhaha, narcotics would need to be addressed specially until such a time that the government respects its citizens.

Were prescription requirements softened, and moral hazard decreased, competition would reduce the prices of pharmaceuticals and improve access to medications. Additionally, the enablement of true market forces would improve efficiency of targeting capital investments within the pharmaceutical industry—allowing for continual development of better cheaper safer drugs targeting the needs of the patient market as opposed to the politicians’ priorities.

Real, free-market discipline will help us all. More importantly is that the free market is a moral system of voluntary, non-compulsory interactions among free people, the inherent nature of which assures continuous advance to mutual benefit—a system that will lead to better cheaper medications, if only it could be allowed to exist. The prescription mandate stands in opposition to the free market.

Empowerment of patients encourages intelligent personal self-interested motivation to learn. It will help in the process of unbrainwashing the population from being passive recipients of whatever experts tell them, into being once again conscious, thoughtful adult human actors in a grand advancing civil society.

As the nation debates the value of legalizing marijuana, let it also consider the value of freeing patients from the manacles of prescriptions in general. Remember, removing those manacles will limit patients in no way at all. Instead it frees them to benefit in so many ways. I would love to discuss it here in the forum.

John Hunt, MD is a pediatric pulmonologist/allergist/immunologist, former Associate Professor at the University of Virginia and the author of “Assume the Physician” and “Higher Cause” as well as Liberty.Me’s guide “Surviving Obamacare”.