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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.

The Dr. A Show


I'm very excited to announce that Mother Jones RN will be joining me this week on Doctor Anonymous Live! Tune in Thursday, October 4th from 10:00-10:30pm eastern time. (Need a time conversion chart? Just click here.) MJ will be hosting Grand Rounds next week. Click here to see what her theme will be.

We'll talk about Grand Rounds and what ever else comes to mind. If you remember, MJ was gracious enough to call into my very first show. Thanks so much MJ!


Not only can YOU listen live to the show, you can also participate by calling into the show and/or in our LIVE chat room. Never heard my show before? What's wrong with you? LOL. You can listen to an archived show in my sidebar. You can also check out my Blog Talk Radio site.

Finally, as an added bonus, I will have a Major Announcement that I'm going to make sometime during the show on Thursday night. YOU will definitely have to listen live to check out what that is? (What could it be?) Hope you'll be able to join us! Spread the word!

Let's Make a Deal

I enjoyed watching this game show when I was growing up. While watching the show, I thought to myself, "Would I really trade this for that to make a great deal for myself?" What really is a good deal? I guess that's in the eye of the beholder.

Well, now the band Radiohead has taken this to an entirely new level with their latest album. Ever since there has been digital music, there has been a debate on what is a fair price for electronic music. And, you can't have a discussion like this without talking about music piracy.

Here's what the band has on their website (NY Times):

Yes, that's right, you fill in the price that you want to pay. This is not a joke. Believe me, when I first read the title of this article, I really didn't believe it. But, it's real. For a minimum of one British penny (about two American cents), you can have not only one song - but the entire album.

There is no maximum price, nor any other guidance, setting up what is may be the biggest experiment in digital-era music-industry pricing to date. What are people willing to pay for music? How many will pay full price? How will the average price compare to what a typical record company would likely have charged? Will people pirate it anyway?
This is a pretty daring experiment - one that may redefine how music is bought and sold on the internet. I know that the Apple iTunes people and the record labels are going to be watching this very closely. I didn't even know about this band until this story, but now, I may even check them out.

Grand Rounds


Grand Rounds 4.02 is now up and running over at Musings of a Distractible Mind. Dr. Rob has the creative theme of the Cat In The Hat. Thanks so much for including my post this week.

Doctor A ponders with back pain who wins:
Those treated with pills or those poked with the pins?
If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science?

Next week, GR moves to the blog of Mother Jones RN entitled Nurse Ratched's Place. She has already picked a theme which will be a "a tribute to the doctors, nurses, and other health care professionals who are serving in the Armed Forces."

Thanks again to Dr. Rob for being a guest on Doctor Anonymous Live last week. If you haven't had a chance to check out my interview with him, I encourage you to click this link or check out the audio client in my sidebar. Enjoy Grand Rounds!

Breast Cancer Awareness Month


Since it is the first day of October, this is the start of Breast Cancer Awareness month. If you're looking for a good resource of information, the American Cancer Society has a lot of good stuff. I encourage you to check it out.

I was also reading this article from the Chicago Tribune this morning which reviews a new survey stating that there is still a lot of misunderstanding out there as far as the facts about breast cancer.

One "stunning" example, she said, is that people still believe heredity is the cause of most breast cancer cases, although in reality only 5 percent to 10 percent of breast cancer is caused by genetic mutations that can be inherited.

The survey, being released Monday, the first day of Breast Cancer Awareness Month, also found that 7 out of 10 women believe eating enough fruits and vegetables can help prevent breast cancer. In reality, there's no good evidence that this is true.

Most women (and nearly two-thirds of those age 18 to 24) believe breast cancer can be prevented. In reality, there are only a few things women can do to reduce, but not eliminate, the risk of developing the disease, such as not drinking alcohol and not taking hormones. The biggest risk factors are being female and getting older.

Unfortunately, the end of this article is a political commercial for a website. They also state that they are going to make this an issue in the US presidential election. So, again, the press taking advantage of cancer patients to push their political agenda. It's really unfortunately and frustrating how these people make pawns of cancer patients for their own political purposes.

Avoid OTC cough meds for kids


Fall really hasn't set in here yet (temps are still close to summer-like numbers). But with school back in session, the cough and cold season has definitely returned. Everyday I hear of kids' coughs and fevers and other respiratory symptoms.

Also, everyday, I hear questions of what to give kids less than 2 years old for these symptoms. Apparently, according to the FDA, avoid over the counter cough meds in these kids (ABC News).

In a report released last week, safety experts within the Food and Drug Administration said they would recommend NO level of dosage for children under the age of two, "due to the lack of evidence of efficacy and safety concerns."

"There are a variety of problems that can occur, and there have been some deaths associated with cough and cold preparations," says Dr. Janet Serwint, who signed a petition, asking the FDA to warn parents about the dangers of these medicines.

Even more amazing, the industry itself — while insisting its medicines are safe — now agrees they should not be given to very young children.

"Parents should not use these products for children under 2," says Linda Suydam, president of the Consumers Healthcare Products Association.

Last week, I was asked about these types of medicines for kids under 2 years old, and I related the FDA concerns. The parent then told me, "Then, you expect my child to cough all night? There's got to be something to give him to bring the stuff up, right? How about an antibiotic?"

I predict that with this FDA advisory and subsequent news reports - that docs will be pressured even more to give kids antibiotics for what seems to be viral infections. I'm telling docs out there (including myself) - Stand your ground!

If you think your patient (whether they be a child or adult) doesn't require an antibiotic, then say so. It's going to be difficult (I go through this everyday), but I know you can do it!

Epilogue: Dr. A Live - Episode 5


What's up with the picture above? We'll you'll have to listen to the show to figure it out. HA! Listening to the show is as easy as going to my blog sidebar and hitting play. Or, you can even download and subscribe to the show via iTunes.

You can also visit my Blog Talk Radio site. While there, don't forget to pick up a promo button to place on your blog for me (please!). Also on the site you can give a rating to my show, leave a comment, make me a BTR friend and BTR favorite. Thanks!

Thanks so much to Dr. Rob for joining me on the show. I never actually knew what his voice sounded like until the show tonight - so that was exciting.

Definitely write a post and send it over to Dr. Rob for his Grand Rounds on Tuesday. I also have to tell you that he might have given a hint on his GR theme during the show. But, of course, I'm not going to tell you. You have to listen to the show. HA!

Thanks also to those who called in and those in the chat room during the show. Right now, I'm going to plan for Thursday nights at 10pm and see how that works. I still my try a different day/time. But, we'll see how this works for now. Have a great weekend everybody!


Update: Thanks to Scan Man and JMB for letting me know that the show is NOT available on iTunes site outside the USA. Bummer. However, all is not lost. The show IS available via RSS feed. Just click here or here and download away!

The Dr. Rob Interview (maybe)


Thursday, September 27, 2007 from 10:00-10:30pm Eastern Time


I'm happy to announce that the one and only Dr. Rob from Musings of a Distractible Mind is scheduled to appear on the Doctor Anonymous Live show tonight. Dr. Rob is going to be the host for Grand Rounds next week.

What are we going to talk about? You'll get some insight on how it is being a GR host. We'll also talk about his blog. I've enjoyed his physical exam series and his Ask Dr. Rob posts. I'm also curious about his recent blog troubles (even last night, his new site and old site were down for a little while).

We'll also be taking your phone calls and hoping you join the chat room. If you can't listen live, that's ok. This show will always be available via the archives. (see the links above)


Disclaimer: This appearance was just set up yesterday. Dr. Rob told me that he's at a conference today and would probably be available at 10PM tonight for the show. If he can't make it for one reason or another, it's just going to be me. So, you'll have to tune in to see what happens!