Rx for largesse

Ever heard of those massive giveaways pharmaceutical companies give to doctors to get them to prescribe a particular drug? The fancy dinners under the guise of educational presentations, the free textbooks, the endless parade of logo-embossed tchotchkes? Liberals would love to get rid of these by outlawing them, because supposedly these gifts are the reason that drugs are so expensive today.

Let's lay aside for the moment the fact that FDA-required clinical trials cost many, many times more than a drug company will ever spend on marketing materials, and are therefore much more responsible for the price of pharmaceuticals. You may still find it annoying that, when you pay for your Lunesta or your Cialis or whatever brand-name drug you may be taking, you are footing part of the bill for gifts from the pharmaceutical company to your doctor -- gifts that perhaps influenced your doctor to prescribe that drug to you in the first place.

The way to drastically cut down on these tchotchkes is not to outlaw them (a violation of the drug companies' right to free speech). It's to get rid of the prescription drug system altogether. I propose that an individual has the right to purchase whatever drugs producers are willing to sell him, unfettered by a doctor's prescription.

But wait! you say. Patients can't be trusted to manage their own health! Nobody would see their doctors any more, and people would poison themselves by the thousands!

But an individual has the right to do what he pleases with his own body. If a man is foolish enough to swallow an intravenous chemotherapy drug, he is violating nobody's rights in doing so. If he decides to poison someone else with that drug, then he is a criminal, condemned by laws that already exist.

I'd like to think that most people are not, in fact, that stupid: that in the absence of a prescription requirement for drugs, the wise patient would continue to seek medical advice from a doctor when necessary. But the advice would be just that: advice, and not a prescription coercing the patient not to try any other options. So, if a doctor prescribes Drug X out of habit, and the patient does some research and finds that Drug Y has similar efficacy with slightly higher toxicity, but a much lower price tag, and the patient decides the cost savings is worth the risk, he can get the drug he wants. Then the ultimate responsibility is where it belongs: with the patient, the person actually taking the drug.

The way the system works now, the person who decides what drug gets used is not the person paying for, and taking, that drug. So, instead of offering a coupon for the patient to save money, the drug company offers largesse to the doctor. Put the final decision-making power in the patient's hands, and the pharmaceutical company's promotional focus shifts. In order to gain market share, the drug company would then have to market directly to consumers, with the doctor as a secondary focus. I bet those steak dinners would turn into patient rebates pretty quickly at that point.

Furthermore, getting rid of the prescription requirement would help to take politics out of medicine. The most infuriating example, to me, is birth control. Why can't I buy it off the shelf at the local pharmacy, when birth control pills are just as safe as any drug already available over the counter? Because the religious right would have a cow, that's why.

Plenty of Objectivists have correctly argued for the legalization of currently banned drugs on the principle that drug use violates no one's rights. Let's extend that principle to getting rid of prescription law as well.