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Comment by ivraatiems | Hacker News Reader

I didn't get much farther than the author describing how doctors "prescribe Ibuprofen." Ibuprofen is an over the counter medication. No doctor actually writes a script for it; they just say "hey try this for your pain." They make no money off saying that, or recommending ibuprofen over tylenol or whatever, because these are not prescription medications and doctors aren't being courted by pharma companies to push OTC drugs everyone already likes and knows about.

They actually recommend this because Ibuprofen and Tylenol are widely available, cheap, and very safe. (Unless you take too much Tylenol, which, seriously don't.) Most people already have a bottle of one or the other or both.

There are actual drugs doctors sometimes get rewarded for prescribing, in various ways, but OTC pills are rarely it. See opioids, for example: https://www.healthline.com/health-news/is-your-doctor-gettin...

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> No doctor actually writes a script for it; they just say "hey try this for your pain."

Author here.

I don't mind criticisms of my essay, but that is factually incorrect. Doctors do in fact write prescription for over the counter ibuprofen in the United States and often do so as a remedial solution to various ailments, which may or may not benefit from pain relief.

I'm not saying it doesn't happen but it's not standard practice to write a prescription for an OTC med unless there's a reason (you need a higher dose, you can get it cheaper via insurance if it's prescribed, etc.).

In fact, the practice is uncommon enough some physicians have found the "loophole" situations I mentioned above too burdensome: https://amednews.com/article/20120507/government/305079963/1...

You went from "no doctor" to "not common".

It is in the UK in many cases. The reason might be 1) need a higher dose than allowed to sell OTC, 2) get it without paying, especially for elderly, but this practice is frown upon, 3) simply to streamline pharmaceutical care and include all needed medicines on one prescription, again, this is more common for elderly on several medicines.

We are not talking about ibuprofen here because that's actually bad for stomach and heart. Most common in the UK would be paracetamol. But many other OTC medicines are being routinely prescribed (painkillers like codeine). I was prescribed ear drops that the pharmacist advised me to buy OTC because that would be cheaper than pay the prescription fee.

I guess that for many patients going to the doctor and getting a prescription for something is part of their expectations that they would not be happy to return without anything.

But of course, the practice among countries may be very different that we cannot talk about one single culture. I think of author's article more like an allegory.

Prescriptions are occasionally written for OTC meds so that they can be covered by medicaid, FSAs, etc.

Also, NSAIDs are not just for pain control. They are also anti-inflammatory (e.g. used for pericarditis) and can be used in more obscure circumstances such as closing a PDA in an infant.

Every time a doctor has "written me a prescription" for an OTC, it's always been just a note to me to actually get it. They never bother to send it to the pharmacist, and I end up being just another nameless person to the pharmacist buying another pack of Tylenol.

To be fair, the quoted piece doesn't say "write a prescription for ibuprofen". It says doctors "prescribe ibuprofen". The former implies an actual written prescription you might give to a pharmacist, the latter is more ambiguous and can mean that the doctor told you to take ibuprofen. As in: "For my cold, the doctor prescribed plenty of rest and fluids".

Do you have any evidence for this? As an American who's been to many doctors, this just seems wrong.

The article mentions selling ibuprofen, not prescribing it, so it's even worse.

My dad practiced dentistry for ages, and would write prescriptions for ibuprofen. It's about the dose, frequency, and duration. You can of course buy the pills without a prescription.

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