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Comment by athenot | Hacker News Reader

I have mixed feelings about this, especially considering the US is the only first world country where direct-to-consumer marketing is allowed for medications.

Bypassing the prescription requirement is of course of significant value to drug companies, who expend quite a bit of resources to sway doctors with free lunches, conferences and soft persuasion tactics.

Usually I welcome the freedom to chose but this doesn't increase availability: the bottleneck is not with the doctors, it's with pricing. Drug prices aren't going to go down with this measure, and will remain 3-5x the price of the exact same meds sold in Europe.

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One of my friends has type I diabetes, in more than one times, she needed urgent visit/call to her doctors just to get the medicine she has being taken for years.

I have type 1 diabetes, and this is a constant fear of mine. It’s absurd that I should have to go through my insurance company to be able to get more medicine if I need to.

This is the most atrocious thing to do by not to letting people with Type 1 buy their Insulin medication. I just don't see a reason why this is so much regulated. Like some meds which are partially regulated, where you can request a Pharmacist and they can give you would be reasonable in this case.

Insulin is regulated because you can very easily die from using it improperly.

Older versions are available OTC in at least parts of the US.

I don't know if this is helpful to you, but Walmart pharmacies have inexpensive insulin if you ask for it.

This is regular insulin, its quite unstable (by unstable I mean that its release mechanism is quite slow and requires a lot of planning compared to more modern 'fast acting' insulins.

with that said, as a type 1 - if I was in a predicament you bet i would go, if i recall they sell it for 25 a vial, whereas a vial of normal, fast acting insuling is ~250.

*usd

I had this realization after a family emergency had me flying cross country on, 2 hours warning.

Walmart sells Novolin R/N for 25$ a vial without prescription. In all but three states I think, it is legal to purchase veterinary needles.

Novolin isn't probably as good as what you've been prescribed. But it will keep you alive.

What you’re talking about goes far beyond what the FDA is proposing.

The drugs the FDA wants OTC are drugs that have already gone generic like statins. There is very little financial incentive to push consumers to buy drugs they don’t need.

> There is very little financial incentive to push consumers to buy drugs they don’t need.

I have to disagree: Homeopathics and Viagra.

In general I am in favor of this change, but homeopathy and vitamins are 'generic' and companies see a huge incentive to sell them, even if we do not need them. Supplemental vitamins are mostly wasted when you urinate.

Viagra is another drug I can (and do) see a lot of money spent to encourage people to take even if they do not need it.

The margins on homeopathic are way higher than generic drugs and there is a ton of competition among manufacturers.

Most generic companies make their profit off the first 6 months of exclusivity. The rest of the time they are barely breaking even (hence the drug shortages).

> Most generic companies make their profit off the first 6 months of exclusivity. The rest of the time they are barely breaking even (hence the drug shortages).

I read that it was due to factory outages and the government keeping tight control over production of controlled substances. The FDA actually forced Pfizer to give up their quota this year to other manufacturers because they didn't produce enough of it due to their factory outages. It seems more like a large business playing hardball with the government and insurers than a lack of profit.

Also, you need to provide proof of your assertion of generics barely breaking even. I just glanced at Mylan who sells generics. They bring in 2B a year in operating cash flow on 12B in revenue.

> the US is the only first world country where direct-to-consumer marketing is allowed for medications.

Not quite. It's allowed in New Zealand too. There have been many calls to change that, but so far it's still allowed.

It's not quite as bad in New Zealand as the states though, since most of the time if you go to the doctor they'll prescribe you generic, state subsidised medicine.

I've never really noticed much direct-to-consumer marketing, except for Viagra and Cialis.

I haven't watched broadcast TV in years, but I certainly remember quite a bit growing up - maybe rules have tightened? I have no experience with US advertising, but yeah, privatised medicine must lead to issues we don't get.

> especially considering the US is the only first world country where direct-to-consumer marketing is allowed for medications.

Relevant book on this topic, and highly recommended read: https://www.amazon.com/Overdosed-America-Promise-American-Me...

So ease access to the drugs and tighten the regulations around advertising. The fact we have consumer-driven ads for prescription drugs at all is like something you'd expect in a satire novel :P

Making it easier to get drugs exacerbates this problem: people start widely prescribing themselves drugs that do them harm, in combinations they don’t understand, all believing what the pervasive advertising mind-control system tells them to believe.

Our current situation is terrible; this just makes it worse.

The cynical view is that other countries have restrictions around drug advertising because if an expensive drug is demanded they have to pay for it through their single payer system. I can imagine not wanting the population to find out that there is cure for Hepatitis C but it costs the country 20k per person. Not all countries are as forward thinking as Australia:

http://theconversation.com/australia-leads-the-world-in-hepa...

Only New Zealand and the US allow prescription drug marketing directly to consumers. And yet, all other developed nations seem to be doing well managing pharma access for their citizens.

A cynic might think this policy is intended to juice US pharma profits.

idk, the past few times I was in Russia I saw a plethora of adverts on TV for drugs.

Not prescription drugs.

While I applaud cynical views in general, since most of the rest of the world has restrictions on the prices of prescription drugs this idea doesn't work in most cases.

There is a more cynical view, and you should definitely take it. Less doctor involvement means more people taking prescription drugs (the pharma companies hope).

As an aside, I cannot tell you how angry our direct-to-consumer drug advertisements make me. Especially the ones that are marketed to people with terminal diseases offering them hope (but in the small print offering perhaps 3 months longer life, not guaranteed).

Everyone involved in the process should be ashamed of themselves.

> As an aside, I cannot tell you how angry our direct-to-consumer drug advertisements make me. Especially the ones that are marketed to people with terminal diseases offering them hope (but in the small print offering perhaps 3 months longer life, not guaranteed).

After reading an related article (http://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/) a few weeks ago, it's no surprise that the market has answered the calls of those who really do want doctors to do everything and anything to prolong their loved ones lives. The selling point for these medications are hope, and I agree that it'd be sensible to regulate advertisements so consumers can truly weigh the benefits versus the costs before they in an emotional state.

thanks for the link, it was a good read.

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