Mark N. Hertzendorf

September 1995

In this essay I enumerate several important reasons for making more drugs available over-the- counter ("OTC").

Less Government Equals More Equity: Prescription drugs are "generally" available to the wealthy and middle class. However, lower-income individuals and families often don't have the same access to doctors as the rest of us. This often causes poor people to suffer disproportionally, as the result of untreated medical conditions. Permitting many more drugs to go over-the-counter would, therefore, provide tremendous benefits to the poor.

Consider two drugs: the acne medicine Retin-A, and the anti-depressant Prozac. The main hurdle to acquiring Retin-A is, of course, the need to get a doctor to prescribe it. Since doctors are expensive, this hurdle is much more readily jumped by the rich than by the poor. While some rich people are taking Retin-A to reduce wrinkles, poor people with serious acne are left untreated. Given that the drug has been around for years, and used by millions, it is hard to believe it is not safe enough to go OTC. The main side effect seems to be that if you use too much of it, your face will become temporarily irritated. Of course, if you're a mouse and live under an ultraviolet lamp, you might get skin cancer. But if you're a human and don't live under an ultraviolet lamp, it can make precancerous lesions disappear.

The main side-effects of Prozac are a reduced sex drive and insomnia. I don't recall if a study has been done, but based on what I see, many of the homeless people on the street are either depressed or suffering from schizophrenia. Now, it seems to me that if I was a terribly depressed homeless person, I'd be willing to risk the side effects. If it works for some people, then perhaps homelessness can be reduced as people overcome their illness and become functioning members of society. There doesn't seem to be any risk of abusing the drug since it doesn't make you high.

I'm not suggesting that the poor should have access to exactly the same health care as the rich. What I am suggesting is that inequalities which are the result of government over-regulation are despicable.

Reducing Medical Expenditures: The necessity of going to the doctor to get a prescription for a common malady wastes money and drives up the cost of medical insurance. Although, no one will doubt that some medical conditions require the intervention of a professional, the majority of doctor visits are probably used to acquire routine prescriptions such as allergy medicines (and antibiotics, ED). There can be no question that the primary beneficiaries of prescription medicines are doctors, not patients. For example, the main group lobbying against bringing Gynalotramin over-the-counter were gynecologists.

Reducing the Stigma of Disease: Bringing more drugs OTC would reduce the stigma associated with various medical conditions and thereby increase the level of treatment. For example, putting condoms on display in drug stores has reduced the embarrassment of purchasing contraception, and has made it a routine part of life. How many people, I wonder, are left undiagnosed or treated because they are too embarrassed to admit they have serious conditions? In some professions (politics) it is even a death sentence to admit that you are suffering from depression. OTC drugs could help make the treatment of depression a "nonevent." Or consider impotence. How many men are left untreated because they are too embarrassed to admit they have a problem or to discuss it with their doctors? OTC drugs permit treatment to be a private affair and thereby reduce the stigma associated with having various diseases.

Reduce smoking: Millions of American are addicted to nicotine. There is a safer alternative to smoking: nicotine gum. It is only available by prescription, and then only if you can convince your doctor that you want to use it to help you quit smoking, The death and illness associated with smoking could be reduced if nicotine gum were available OTC so that people could use it as a regular alternative for smoking. A safer cigarette that heats the tobacco rather than burning it, is also in the works. Let's hope the FDA does not decide it's a prescription drug and thereby needlessly condemn hundreds of thousands of citizens to lung cancer.

The FDA will nag us into our own demise: The FDA's traditional response to criticism has been thalidomide -- the drug that caused birth defects in Europe during the 1960's, but was never approved here in the U.S. However, thalidomide is irrelevant for the current discussion. I have only discussed taking drugs that have already been approved by the FDA as safe and effective, and making them available OTC. Besides, for the FDA to bring up thalidomide every time its competence is questioned, is a bit like NASA trying to avoid budget cuts by referring to successful Moon landings 25 years ago, The real question we should be asking the FDA is: "What have you done recently?"

Perhaps some would argue that consumers are too irresponsible to self-medicate themselves. Certainly the FDA has encouraged us to be irresponsible. By making sure that drugs have their potency curtailed before going OTC, the FDA has encouraged consumers to ignore directions and exceed the recommended dosages. If this is a habit consumers have gotten into, we can thank the FDA. In addition to the FDA, and a plethora of litigation, have encouraged drug manufacturers to warn us about an endless collection of extremely unlikely and not too serious side effect associated with every medicine. The procedure of warning us about "everything under the sun, " distracts consumers from a more balanced and appropriate consideration of potential side effects. Finally, I have no doubt that some consumers are currently abusing, and will continue to abuse OTC drugs, but this cost must be weighed against the enormous benefits associated with OTC drugs. Given enough time and enough dangerous drugs, most consumers will gradually learn to treat themselves sensibly. The alternative is to make us forever hostage to the power of doctors.