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.
The article does mention one class action suit brought against PayPal for "mistakenly freezing the accounts of several users for up to a week while it investigated suspicious activity." The "several users" were actually thousands of users, and it was not "up to a week," but a minimum of six to eight weeks before they would even begin to review your case.
Besides myself, I have known five other people who have had their accounts frozen without warning and without a reason given. The funds were frozen for at least six months, at which time we could "ask for our money back." They would then, apparently, let us know if we could have our money.
Then there is PayPal's "innovative" customer service. Those not trying to glamorize the company would call it terrible. Forbes just called it one of the five worst companies for customer service. The people were amazingly rude, the wait times were horrible, and nobody who worked there ever seemed to know what was going on or cared.
The article also failed to mention the glitches in PayPal's transferring programs that would randomly make a customer's money vanish into thin air. PayPal would not be able to find what happened to the money and often apparently didn't care, resulting in many more "frivolous" lawsuits.
As the many thousands of personal stories on sites like paypalsucks.com attest, PayPal was a poorly-run, inefficient, and corrupt business.
Radley Balko replies: Many of Jon Sloan's complaints are anecdotal. Other policies he complains about, including giving a buyer 30 days to register a dispute, seem reasonable. Still others are the result of PayPal reacting to government actions against it. The company froze funds, for example, in response to heat it was getting from government officials for not adequately addressing fraud (and under the threat of subjecting the company to banking regulations).
Certainly, PayPal experienced growing pains in the early days as it tried to scale up its customer support staff to meet its growing customer base. What's undisputable is that before the eBay takeover, PayPal quickly and decisively became the top online payment service in a young market with numerous well-funded competitors. It's hard to see how that could happen if the company were as hostile to consumers as Sloan suggests.
Under the Spell of Malthus
Ronald Bailey's review of Jared Diamond's Collapse ("Under the Spell of Malthus," August/September) was excellent and raised important public policy issues. But Bailey's happy scenario for the 21st century is no more certain than Diamond's gloom and doom.
Many of the improvements Bailey discusses are one-time-only efficiency upgrades or are otherwise self-limiting. In science and technology, astounding progress marches alongside maddeningly simple but seemingly unsolvable problems. In the last 50 years, the density of data on computer disks has increased 500 million times while the energy density of batteries has increased only marginally. While we can grow more food than we do now, there is a limit somewhere out there.
CORRECTION: In "Freedom Riders" (November), Jeff Hennie, vice president for government relations at the Motorcycle Riders Foundation, was misidentified as "head" of that organization in a subsequent reference.