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AMA to USA Today: Opposing view: Don't bypass physicians

May 6, 2012 (published)

USA Today
Letter to the Editor

To the Editor:

As physicians, our primary concern is ensuring the health and safety of our patients. The Food and Drug Administration has offered a new concept to make more prescription drugs available over the counter (OTC). Proponents claim it could improve patient health and outcomes, reduce patient costs and promote proper medication use. We are skeptical that it would achieve any of these goals.

The American Medical Association is concerned about patients taking certain drugs without physician involvement — especially patients with chronic diseases. No evidence has been offered that the innovative technologies underpinning this concept would actually allow patients with high blood pressure, high cholesterol, asthma or migraine headaches to self-diagnose and manage these serious chronic medical conditions safely on their own.

As a chronic condition evolves, treatment changes are often needed from a physician. Without physician involvement, patients might take the wrong medication or dose for their needs, potentially causing harm. Self-diagnosis and treatment conflict with the care coordination and disease management that new health care payment and delivery models are trying to achieve.

Contrary to claims that this will save patients money, out-of-pocket costs for insured individuals, including those under Medicare, would increase for drugs switched from prescription to OTC status because patients would need to cover the entire cost themselves. Higher costs would make it harder for patients to afford the medication they need.

Patients are more likely to take the medicine they need when they need it while under a doctor's care. Physicians are one of the most important motivators in getting patients to take medication as directed. Any proposed expansion of OTC medications needs to preserve, not undermine, the patient-physician relationship.

Patients rely on physicians to provide sound diagnosis and treatment information and to help them meet their unique health needs. Expanding many prescription medications to OTC interferes with that important relationship without offering any real benefits to improve patients' health or reduce their costs.

Peter W. Carmel, MD
President, American Medical Association