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Pharmacy could gain prescription power

12-Nov-2007: Some prescription drugs soon might be available without a prescription -- just a chat with a pharmacist.
The U.S. Food and Drug Administration is considering creating a category of medicines, midway between prescription and non-prescription drugs, that would let pharmacies dispense them without a doctor's input.

No drugs have been identified as candidates for such status, but the idea is controversial. Some consumer groups and pharmacists like it because it would be more convenient for patients. Physicians' groups, however, are lining up against the proposal, citing safety concerns.

"This has been an age-old discussion that's getting some recent attention," said Thomas Mattei, associate dean of Duquesne University's School of Pharmacy, who supports the concept.

A similar idea was put into practice decades ago, he said. In the 1960s, pharmacists dispensed non-prescription medications that had the potential for addiction and kept track of what was given, he said. The practice stopped in the mid- to late 1970s, he said.
"The intent was -- just as the intent is now -- to improve health care accessibility," Mattei said.

He likens the proposal to Gov. Ed Rendell's expansion of duties some health care workers, such as nurse practitioners, are allowed to perform.

The FDA will have a hearing Wednesday to discuss public health benefits of a new drug category and is accepting public comment through Nov. 28. The agency hasn't set a timetable for reaching a decision.

At least 11 other countries, including Canada, the United Kingdom and Germany, allow pharmacists to dispense some prescription drugs without a doctor's involvement.

The American Medical Association opposes giving patients prescription drugs without a physician's input, but the American Pharmacists Association supports it, according to the News Journal in Wilmington, Del.

The idea is getting mixed reviews at local pharmacies.

"I think it's probably a good idea," said Jeff Wilson, a pharmacist and owner of Wilson's Pharmacy in Lawrenceville. "I think anything the FDA would recommend would probably be reasonable.

The FDA might set stricter limits on quantities that could be dispensed without a prescription, he said.

"I don't like it," said Dave Manns, owner of Manns Drug Store in White Oak. "I don't think pharmacists should be prescribing medicine."

Some medications have side effects, such as raising blood pressure, and doctors should assess whether a patient could tolerate them, he said.

"Would pharmacists be checking people's vitals, too?" he asked. "There's a lot of responsibility prescribing anything, even over-the-counter medications."

Experts differ on what prescriptions they believe most likely would be approved for dispensing without a doctor's order.

Some experts think birth-control pills and migraine pain relievers could be among the first considered.

Wilson said he does not expect birth control pills to be included, because of the risk of blood clots that accompanies that drug.

"Anything that requires a physical, I don't think they would be letting us dispense," he said. More likely candidates, he believes, are drugs used to treat symptoms, such as coughs, colds or diarrhea, rather than conditions.

Wilson doubts antibiotics would be included. Doctors can order lab tests and cultures to determine the best antibiotics to prescribe, something pharmacists can't do, he said.

Mattei, however, said he believes long-proven antibiotics, such as penicillin, could be included, as well as blood pressure and cholesterol medications. The criteria, he said, likely would be drugs that have been used by a large percentage of the population without any untoward side effects and those that have been widely effective.

The potential for patients' diagnosing themselves troubles Dr. Stephen Permut, who chairs the department of family and community medicine at Temple University School of Medicine.

"They might be having tension headaches, or they might be having a brain tumor," he said.

Source: Pittsburgh Tribune-Review

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