DOCTORS’ LOUNGE
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leukotriene inhibitor it can help allergies
and asthma, two diseases ubiquitous in
the Ohio valley. Its rather long list of drug
interactions is nothing to sneeze at, but
its ability to treat chronic allergic cough,
chronic rhinorrhea, and chronic wheezing
is a huge benefit to people who live here,
in the allergy capital of the United States.
I nominate this as “behind the counter”
over-the-counter, the way we do with Sudafed here in Kentucky. No prescription is
required but the pharmacist is alerted to
any drug interactions that the ordinary
person might well miss. I don't think that
albuterol should ever go over-the-counter
as an inhaled medicine. It is too easy for
people to overuse an albuterol inhaler
without using any kind of steroid inhaler,
and that is what leads to deaths from asthma: excess use of albuterol in the context
of severe attacks. Plus, patients insist on
using metered dose inhalers incorrectly
without careful reminding and teaching.
Naloxone is already “behind the counter”
in Kentucky if the pharmacist has a naloxone protocol that has been approved by
a doctor licensed in Kentucky. As of this
spring, over 200 pharmacies across Ohio
and Northern Kentucky had set up authorization.
However, there are numerous pitfalls for
drug safety when medicines are changed
to OTC. Research done on advertising for
drugs before and after shows that when the
drugs were available by prescription only,
attention to risk was addressed 70 percent
of the time, yet when switched, only 11
percent of the time. Regulation of advertising over-the-counter is then changed
from the FDA to the Federal Trade Commission, which has no absolute requirement for disclosure of contraindications
or bad side effects.
Therefore patients can buy medicine,
spend more for it than they might with the
drug co-pay, and take it without awareness
of potential harm. Overdoses can occur on
any sort of medicine obtained in any sort
of way; aspirin and Tylenol overdoses are
more dangerous than many prescription
drug overdoses. Involving the pharmacist
is important for some but not all medicines. The VA recently did a study comparing pharmacist-led management of
chronic diseases with physician or nurse
practitioner-led management. There was
no increased benefit by having pharmacy counseling for every medicine, so far
as disease control, ER visits, costs etc. On
the other hand, in France the pharmacist
is the point of contact for most ordinary
ailments that are not severe. The French
pharmacist can prescribe what seems suitable. I doubt this would ever happen here,
because of the way medical care is paid for.
Birth control pills are “formally “ available
over-the-counter without a prescription in
several Eastern European countries, Portugal, and Greece, but not in France. They
are fully available without a prescription
in China, India, several African countries,
Egypt, and Cuba; and they are quote “informally available” without prescription in
nearly all of South America, large chunks
of Africa, Russia, parts of Southeast Asia,
and nearly all of Polynesia. (Hmm - no
data available for Antarctica.)
Since 90 percent of American women
eventually use birth control pills, a highly
reliable, safe and easy form of contraception, and I am fairly certain it will make
some enterprising capitalists’ bottom line
very happy: it’s time to catch up with the
Commies, comrades.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Barret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
DON'T BE A BOOB - SUPPORT
BREASTFEEDING
John L. Roberts, MD
D
uring the 10 years, 1893-1903,
the infant mortality of Villiersle-Duc, a small village in the
Cote d’Or of France, was zero due in part
to the fact the village’s medically trained
mayor, M. Morel de Villiers, provided free
medical care to pregnant and post-partum
women and awarded a bonus of $0.50 to
any nursing woman who could produce a
24
LOUISVILLE MEDICINE
1-year-old child in good health as a result of
continuing her nursing for the entire time
recommended.
August is National Breastfeeding Awareness Month. The Healthy People 2020 initiative calls for 82 percent of newborns to
receive breast milk in the newborn period
and 26 percent of infants to be exclusively
breastfed through six months of age by the
year 2020. According to the Centers for Disease Control and Prevention, approximately
77 percent of US mothers start breastfeeding
immediately after birth, but only about 16
percent of those moms are breastfeeding
exclusively six months later. The latest Kentucky statistics, based on babies born in our
Commonwealth in 2014, showed 61 percent