Locking Up Life-Saving Drugs
Thanks to Kerry Howley for saying what I have wanted to say for years ("Locking Up Life-Saving Drugs," August/September).
Being a libertarian and a pharmacist, I have had time to contemplate the issue of why most drugs require physician intervention to begin with. The only valid reasons are patents and protectionism for physicians and drug companies. That, and drug companies and doctors consider laypeople too ignorant to manage their own care.
With the advent of the Internet, drug information is readily available to anyone willing to take the time to find it. I would suggest leaving the definitive diagnosis to doctors, but treatment options must be left to the patient. To say that we as pharmacists and physicians somehow have a mystical monopoly on drug information is fallacious. Go to any Barnes and Noble, and you'll see plenty of pocket-sized books on drugs.
Let's also add professional licensure to the mix of why medical care is so expensive. Look at the disciplinary actions of any licensing board for any given month, and you will conclude that the piece of paper is worthless. But people are so conditioned to think that a piece of paper issued by the state is some guarantee of ethics and professional ability that the likelihood of licensure going away is remote.
The beauty of moving most commonly used drugs to over-the-counter status is that the need for the pharmacist still remains. We can strategically place ourselves as medication management experts and help people stay on top of interactions, side effects, and monitoring drug therapy for efficacy. I have worked in hospital pharmacy for more than 20 years, and since everything done in a hospital must be by physician order anyway, my job is secure. Pharmacists adjusted when drug companies started making finished dosage forms (tablets and capsules) and effectively took most compounding away. We simply have to find ways to make our services marketable to consumers, who deserve to orchestrate their own care.
Joe Haynes, R.Ph., MBA
Self-Medicating in Burma
My experience in Myanmar during the last five decades confirms the experience reported in Kerry Howley's "Self-Medicating in Burma" (August/September).
While the Food and Drug Administration would not approve of much that happens in Myanmar's pharmaceutical industry, it provides pragmatic service to many who would have no access to medicines under the U.S. system. Moreover, the self-medication available throughout the country somewhat compensates for a very low-paid, badly served public health system that must endure with very scarce tax support and extremely onerous U.S. sanctions.
In the U.S., millions must turn to Mexico or Canada to afford drugs that should be available domestically, but for unreasonable restrictions imposed by the five giant pharmaceutical corporations via lobbying, especially since the GOP gained control of Congress and the White House. It is a peculiar consequence that those advocating less government, because of their control over drug production and pricing, more deeply penetrate the daily lives of Americans than liberals ever advocated.
John H. Badgley
University of Washington
Southeast Asia Center
Who Killed PayPal?
Radley Balko's article on PayPal ("Who Killed PayPal?," August/September)--or at least the book he was reviewing, The PayPal Wars--suggests that government interference, frivolous lawsuits, and then the elimination of competition once eBay acquired the company are to blame for its downfall.
As a former PayPal user who has dealt with the company's poor management and terrible customer service repeatedly, I--along with thousands of other former users--can attest to a different explanation. In PayPal's supposed "glory days," buyers using PayPal could dispute a charge and get a refund with basically no questions asked. After the $313,000 fine from MasterCard, the situation changed drastically. PayPal put stringent limits on disputing a charge and gave a buyer a maximum of 30 days to do so, after which all a buyer could do was make a complaint against the seller. No matter the reason for the dispute, no matter the amount of money, the money was gone after 30 days. Those policies are the reason for some of the lawsuits against PayPal, and they are still in practice today.