Behind the counter meds

Everyone has heard about over-the-counter medications. You just walk into your local pharmacy, look around for your favorite cough/cold medicine, or stomach medicine, or pain medicine, or whatever. You take it off the shelf, go to the register, and that's it.

And, everyone is familiar with prescription drugs. You visit your favorite physician, have the appropriate interview and physical exam, receive the prescription, and then go to your local pharmacy to have the prescription filled.

Now, the FDA is looking at what is being called "behind-the-counter" medications. What the heck are they talking about? (With the FDA, sometimes it's difficult to figure out what they are talking about sometimes.) In this Associated Press article, they try to explain what the FDA is looking for.

"Behind-the-counter" sales offer a middle ground. Last year, the FDA allowed the emergency contraceptive Plan B, also called the morning-after pill, to be sold without a doctor's note to women 18 and older — but only by pharmacies that checked women's photo identification before handing over the pills. Minors still require a prescription.

Now the question is whether requiring additional interaction with a trained pharmacist — health advice or even, say, a blood pressure or cholesterol check — might further spur the evolution of nonprescription drugs from quick symptom relief to more complex therapy.

Routine birth control pills are an often-cited candidate. And in 2005, the FDA rejected a bid to sell cholesterol-lowering Mevacor without a prescription — although some of the agency's scientific advisers said such a move might one day be possible if pharmacists could help guide which customers bought the pills.

Now, as far as behind the counter medicines go now, there are certain cough/cold medications which are not OTC (ie - pseudoephedrine containing medications), apparently because of federal law and state law.

However, I think what the FDA is talking about here is distinctly different. I remember a couple of years ago when there was talk about making cholesterol medications available without a prescription. Even though this is done in Britain, I still don't think that it would be a good idea to do that in this country. I believe physician oversight is essential for a situation like this.

The FDA has to be very careful about looking at which medications they are considering to be behind the counter. Giving advice on certain medications and then dispensing them as a pharmacist is one thing. But, then, potentially taking the next step and evaluating/treating a patient for things like elevated cholesterol is something else. This is practicing medicine in my book.