I think that a number of drugs that now require a prescription could be made available over the counter—if the buyer was provided with good, clear information on how to use them.
I think the idea of increased access to a limited number of drugs is very exciting. The number of effective pharmaceuticals available is much smaller than most people think. We have thousands of drugs. But there are only about three or four dozen really widely used and effective therapeutic agents. The average physician prescribes only about two dozen on a regular basis.
I have no doubt that with an effective medical education program in our schools, we could have high school graduates with a level of drug expertise sufficient to safely use many, many drugs that are now available only by prescription.
You were saying that you felt we relied much too heavily on drugs. Why is that?
I think there are four main reasons. Number one is the huge amount of money spent on advertisements for over-the-counter drugs. Kids grow up thinking that pills and potions are the answer to health problems—a pill for your headache, a cream for your hemorrhoids. Just count the number of drug ads on television in one week. You'll be astonished.
Number two is an even more intense effort by drug manufacturers to advertise their products to doctors. There are thousands and thousands of detail people who do nothing but go around to doctor's offices pushing their companies' drugs. Almost every major medical journal, including the most reputable ones, contains gobs and gobs of very impressive and expensively-done drug commercials. That can't help but have a big impact on doctors' prescribing habits.
Number three is the way health workers are educated. Prevention and nondrug treatment are either ignored or given lip service. The message we give health workers is that there's a pill for every ill.
Number four is the pressure from the very nature of the clinical visit to give a prescription. The doctor has perhaps ten or fifteen minutes to see each patient. That's not enough time to even begin to ask how the current problem relates to the rest of their lives. You can't even begin to think about prevention. That's barely time to take a brief history, check your blood pressure, and write a prescription.
And a lot of people will feel cheated if they get advice instead of a prescription.
Absolutely. A lot of the pressure comes from the client. We live in an "instant" society today—with instant hamburgers and instant checking. So when we're ill, we expect instant relief.
There's an economic pressure, too. The doctor who's charging you fifty dollars for a fifteen-minute visit is going to have a lot of difficulty prescribing aspirin— even if that's the best and safest remedy. The person could have done that much for himself.
How can we get away from these patterns?
I think that people have to learn some basic clinical medicine. 1 think that health workers need to help them do this—by stepping out of their authority roles and sharing their uncertainties and their doubts.
I think that medical education needs to stress nondrug treatments. If someone comes in with high blood pressure, most doctors' first thought will be to prescribe a thiazide diuretic, but a much more appropriate first step might be to recommend that the person lose weight, begin exercising, quit smoking, cut down on salt intake, learn new ways of dealing with stress, or apply some combination of these self-care approaches. The drug should be used only as a last resort.