Louisville Medicine Volume 64, Issue 3 | Page 26

DOCTORS’ LOUNGE (continued from page 23) 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