It Isn’t Always Brain Surgery : A proposal for non-physicians to prescribe some medicines
Consumers will note that the box of Imodium A-D, an over-the-counter anti-diarrheal medication, includes the information “Imodium A-D caplets contain loperamide HCI, previously available only in a leading prescription product.†Counter-indications on the box give a clue to why this was once the case. They end with the warning, “If you are taking antibiotics or have a history of liver disease, consult a physician before using this product.â€
There are no completely safe drugs. But clearly our society has changed its mind about how much protection to provide against the dangers of loperamide HCI. Once, a physician’s protection was necessary. Now, a label will suffice.
Broadly, these are still the two options. But on a scale of one to 10, could there not be a middle ground of protection between the zero of over-the-counter access and the 10 of physician prescription?
Perhaps there should be. As Times health writer Shari Roan reported Tuesday, a three-year state project in the early 1980s provided 16 to 95 hours of drug prescription training to various health practitioners below the physician level. Over a three-year period 1 million patients were treated effectively and safely in California.
At a time when health care dollars are rationed and physician consultation is financially out of reach for many, prescription of stated drugs by such trained lower-cost professionals as nurses and physician’s assistants is an option that deserves serious and open-minded consideration.
