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David P. Smith: Obama Administration Ruining Primary Care Physicians
Monday, May 07, 2012 10:12 AM

The current leadership of the Food and Drug Administration (FDA) under President Obama continues the trend of other government agencies which have policies causing continual stress upon all physicians, but especially primary care physicians.  At the end of 2011, deadlines in place for a new format for submission of electronic claims caused tremendous stress all over the country and resulted in bankruptcy for some physician practices (http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm).

The newest idea of the FDA (http://www.gpo.gov/fdsys/pkg/FR-2012-02-28/pdf/2012-4597.pdf) is to subvert the prescription authority of physicians and allow pharmacists to dispense a new third class of medications with little or no physician involvement (http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20120502pharmprescribing.html).  The idea is to let patients come to the pharmacy and use a kiosk to answer a few questions which will decide if it’s “safe” to let them have the medication with solely the decision of the pharmacist; this would include treatments for blood pressure and diabetes which are complex conditions and not easily manageable in certain patients even with physician involvement.  There is thought that this type of availability will improve access to medications, but it would also make medications listed in this new third class not reimbursable by insurance companies, so it won’t save patients what they are thinking.  Just a few years back, patients were misled into thinking that Medicare coverage of prescriptions would help them and prescription costs have skyrocketed since then due to increased inflation. 

If these FDA proposals are implemented, more people might be taking medications, but it is very doubtful that proper usage of the medications will occur.  Physicians spend years learning how to treat patients and constantly have to keep up to date.  Properly treating patients is complex and letting patients answer a few questions at a pharmacy will most certainly not improve the health of the public generally.  What is most cost-effective is not always the best idea and the greatest, but also most absurd, example of this is that letting the patient die will save the most money.  That is the subject of Democrat political attack ads, in which a senior lady is pushed off of a cliff, for those promoting Obamacare, but this same administration is promoting policies that will water down medical care in such a way that it might not be very palatable for anyone, but it will available to everyone.  Many have heard of the old story of a family having soup for supper and some neighbors show up at supper time, so they just add more water to the soup.

The public should oppose this newest idea because it is plainly dangerous.  Instead of cutting costs in a proper manner, the FDA is trying to do so by cutting out the physicians; this plan will increase costs because there will be harm that will occur to patients when physician guidance is not provided to patients who unknowingly will be harmed by this kind of prescribing policy.  The patient-physician relationship should be preserved with physicians being advocates for the patients first.  There are certainly stories that some will bring up regarding harm from drugs prescribed by doctors and the propaganda on media outlets currently are prepping the public to accept pharmacists as more than just dispensers of medications; rightly so, pharmacists provide invaluable additions to the care of the patient, but the contribution to medical care of patients should not be expanded to include what is really the practice of medicine as well.  Some pharmacists are already putting labs in their pharmacies so patients can attempt to interpret results themselves without a physician.  These proposals, however, put patient safety in greater jeopardy than the current mode of practice and most physician groups are speaking out against these policies (http://www.ama-assn.org/ama/pub/news/news/2012-03-22-fda-over-the-counter-drugs.page).   The voice of patients is needed in this debate to preserve the physician-patient relationship. 

Primary care physicians are already in short supply and this will cause even further decline in availability of them, not increase their availability to the public.  Any other profession is not trained to the level that physicians are when physicians are licensed, nor held to the standards that physicians are held; the current Obama administration proposals will increase the proportion of care provided by those with less training.  It might be less costly in the short-term, but will cost more in the long-term and in more ways than just financially.

 

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