RS 199 - Jessica Flanigan on “Why people should have the right to self-medicate”

Release date: January 7th, 2018

Jessica Flanigan

This episode features Jessica Flanigan, professor of normative and applied ethics, making the case that patients should have the right to take pharmaceutical drugs without needing to get a prescription from a doctor. Jessica and Julia discuss a series of related questions, such as: Should there be exceptions made for drugs that have negative repercussions on society as a whole? And what is the morally relevant difference between a doctor imposing treatment on someone without consent, and the government withholding treatment from someone without consent?

Jessica's Book: "Pharmaceutical Freedom: Why Patients Have a Right to Self Medicate"

Jessica's 1st Pick: "Whose Body is it Anyway?" by Cecile Fabre

Jessica's 2nd Pick: "Against Autonomy" by Sarah Conly

Edited by Brent Silk

Music by Miracles of Modern Science

Full Transcripts 

Comments

[Jameson]

Jessica Flanigan makes several good points.

The government does use force to deprive people of access to medications they want. Furthermore, the US FDA takes so long (average 14 years) to approve a new drug, and sometimes never approves a new drug, that US citizens often travel outside the US to get drugs for treatment of AIDS, cancer, cardiovascular disease, and other conditions that most other countries will approve in six to eighteen months.

We should end prohibition on most recreational drugs. People get the drugs illicitly anyway, and the prohibition causes massive violence and corruption.

Even for some older, ubiquitous antibiotics, people should have the right to purchase and use them without a prescription. People can use those types of antibiotics to treat a whole variety of diseases almost as effectively as having complex, expensive medical tests and treatment. We already have lots of microbes resistant to those types of antibiotics, so their use hardly increases the overall risk of antibiotic resistance.

We should hold public actors to the same moral standards as private actors. People should also always question authority.

[Max]

63,000 prescription opioid and other drug overdose deaths is not enough? Need to lower life expectancy even more?
"Life expectancy in US down for second year in a row as opioid crisis deepens"
https://www.theguardian.com/us-news/2017/dec/21/us-life-expectancy-down-for-second-year-in-a-row-amid-opioid-crisis

[Max]

Funny, I was just commenting elsewhere that after legalizing pot, next they'll want to legalize heroin.
Ah yes, Bayer's Heroin cough suppressant, for children's cough, colds, and irritation.
"One ad, urging the use of 'Heroina' to treat bronchitis in kids, shows two unattended children reaching for a bottle of the opiate across a kitchen table. Another shows a mom spoon feeding it to her sickly little girl. 'La tos desaparece,' the ad says -- 'the cough disappears'.
Heroin was restricted to prescription-only use in the U.S. in 1914 and eventually banned by the nascent FDA altogether in 1924, except under very strict medical conditions.
Sure, it's a blast from the past that says nothing about Bayer's corporate culture today. But their sudden re-appearance is a chilling reminder of what life was like in the early 20th Century when companies were permitted to sell anything to anyone, no matter how dangerous, regardless of the consequences."
http://www.businessinsider.com/yes-bayer-promoted-heroin-for-children-here-are-the-ads-that-prove-it-2011-11

[JoshM]

Since the guest’s argument appeals to already established principles of the right to refuse medication and the right to informed consent, and given that medicine is complicated and the consequences of various treatment options are difficult to understand, would the guest endorse requiring patients to at least consult a medical doctor before excercising a right to self-medicate? This would be an application of the right to informed consent.

I’m imagining a policy where the patient would still get a scrip from a doctor, but the scrip would simply attest that the doctor discussed the risks versus benefits with the patient. It wouldn’t be a prescription, or an endorsement by the doctor. (Perhaps there could also be a way to indicate whether the patient is acting against medical advice, in order to protect the doctor from liability.)

There are parallels here to the field of criminal law, where people have a right to counsel, but a defendant may exercise certain other rights contrary to the advice counsel. For instance a defendant may insist on rejecting a great plea deal and go to trial, or insist on testifying at trial even when their attorney thinks it is bad idea.

This approach could readily be extended to include nutritional supplements, alcohol and tobacco, et cetera, alongside prescription medications.

[Jameson]

If people cannot obtain the opiates they want legally, they go to the illicit market, and that creates corruption and violence. Over the counter opiates make sense since they would cause many fewer deaths than adulterated street drugs. Also, legal opiates have a much lower tendency to cause overdose than heroin, and legal opiates would list the total content of drug in milligrams, similar to how we print percent alcohol on alcoholic beverages. The recreational dose of heroin is only about 50% than the lethal dose of heroin, so safer opiate alternatives available for sale over the counter would definitely decrease the overdose deaths. We can also tax the opiates, and put the money into rehab programs and public awareness campaigns. We did this with tobacco and alcohol and it worked out really well.

Most people who would buy medication without a prescription would still seek the advice of a medical professional first. To make this more affordable in the USA, we need some sort of universal healthcare.

[Doctor Doolittle]

may i test this theory? what about childhood immunizations/vaccinations?

[Daniel]

I believe that Ms. Flanigan's argument has several points of serious weakness. The first is that medicine is complicated. Doctors study for many years to attain competence to diagnose and prescribe. The typical patient is completely ignorant of the effects of medicines. A patient who says "I want to take X for my condition" probably has no idea what his condition really is, and knows nothing of the studies of the effects of the various drugs. As a personal anecdote, when I feel sick I read up on my symptoms and diagnose myself. Then I go to the doctor and find out I was completely wrong. People with no idea what's actually wrong with them, and no understanding of medicine, wanting to prescribe for themselves is the poster case for disinformed un-consent. If we lived in a rational society with a good educational system, people would understand critical thinking and be much less susceptible to the blandishments of pseudo-medicine. Sadly, we do not live in such a society.

As for testing and regulation of drugs, nobody who remembers Thalidomide will seriously advocate for looser regulation of drugs.

On top of this, once you allow people to take whatever drugs they want, you will immediately have a blossoming of the number of quacks promoting snake oil and convincing sick people they should distrust their doctors and take quack remedies instead. This is already a very serious problem in the U.S. and elsewhere. The libertarian policy advocated by Ms. Flanigan would give the quacks a field day.

I applaud her, however, for recognizing that vaccines and antibiotics are exceptions. I believe that allowing people to self-medicate would damage society in ways analogous to the damage of people refusing to vaccinate and people abusing antibiotics.

I think the libertarian view is misguided and ignores that we are all responsible for each other.

I do agree that people have a right to refuse end-of-life treatment that would only prolong suffering. I do not think that religious beliefs (i.e. fairy tales) are a valid basis for making medical decisions.

I also applaud Ms. Flanigan for recommending books that disagree with her view. As much as I disagree with her views, she sounds like a really fascinating person.

[Jameson]

I remember Thalidomide and I also know that European and Asian medical authorities approve new medications more than ten times faster than the FDA, and yet they have never had a Thalidomide type issue. We have lots of quacks and phony medications already.

[Max]

It's a corporate propaganda tactic to oppose consumer protection regulations under the guise of protecting consumer freedom. To that end, they create front groups like the Center for Consumer Freedom, "a front group run by Rick Berman's PR firm Berman & Co., originally primarily for the benefit of restaurant, alcohol, tobacco and other industries. It runs media campaigns that oppose the efforts of scientists, doctors, health advocates, animal advocates, environmentalists and groups like Mothers Against Drunk Driving, calling them "the Nanny Culture -- the growing fraternity of food cops, health care enforcers, anti-meat activists, and meddling bureaucrats who 'know what's best for you.'"
https://www.sourcewatch.org/index.php/Center_for_Consumer_Freedom

That's how they got Congress to pass the Dietary Supplement Health and Education Act (DSHEA) that allowed companies to sell drugs without FDA approval by calling them "dietary supplements." They put out ads depicting government agents raiding a home to confiscate vitamins.

[Max]

Jameson, You remember thalidomide, and you say that Europe never had a thalidomide type issue? It was Europe that had the thalidomide crisis, you dolt! It's the U.S. that avoided the crisis because the FDA refused to approve thalidomide all six times that its manufacturer applied for approval.

[Max]

Even if people had a right to possess and use drugs without a prescription, it wouldn't give drug dealers the right to SELL drugs to anyone without a prescription.

[Jameson]

Touche Max, however the FDA tested thalidomide in the USA and 17 children suffered thalidomide-induced malformations in the U.S.

True enough that if people could buy pharmaceuticals and recreational drugs without a prescription, they would have to buy them from a legitimate retailer that obeyed all regulations as to quality, sterility, disclosure of risks, disclosure of concentrations, age restriction, and so forth. This would eliminate the illicit drug trade and all the violence, corruption, and adulteration of the actual drugs themselves. CVS and Walgreen's drug stores do not engage in gang wars, and they do not cut their drugs with arsenic.

When regulations go too far they do amount to authoritarian controls.

Interestingly enough, the FDA disapproved thalidomide on purely safety grounds, as prior to the thalidomide controversy, the FDA did not require proof of efficacy. This itself proves the FDA should stop mandating massive, expensive, and useless efficacy studies that delay vitally important pharmaceuticals from reaching the US market for years. Furthermore, thalidomide actually has phenomenally good efficacy for a wide variety of maladies, and would thus pass the current FDA efficacy study requirements. Really, the US takes about 15 times longer than any other first world country to approve a new drug, and kills a lot of people with the delay. Also the FDA refuses to look at HUMAN studies from Europe and instead demands years and years of multimillion dollar animal studies performed in the USA.

[Max]

And do you expect insurance to cover non-prescribed "self-medication" too, at my expense?

[Jameson]

Max, under the Affordable Care Act (ACA) as a matter of law US health insurance now covers illicit recreational drug use, alcoholism, and all types of addiction !!

We probably need some type of cost effective universal health care and lots of public awareness campaigns about abstaining from self medication and instead going to see a physician first.

[Robbie]

Half way through & I was wondering how close she came to the far right Libertarian view that taxes = slavery. Got to her recommendations and see that she is that far gone.

As to self medicating, I agree with the commenter who said they go to the doctor to find out how wrong they are about what they thought was wrong. Doctors go to school for a reason. Without medicomps like in science fiction we really need them. She also didn't address how she would force the doctor to consult for the non recommended treatment. Drugs have effects, that's why we use them, not all effects are desired and having a Doctor engaged is beneficial.

Snake Oil sales would boom under her guidance. I mean even more than it already is.

[Jameson]

Simply requiring full disclosure to the patient would allow the patient the weigh the benefits and risks of a particular treatment, even if against the advice of the physician.

Snake Oil sales might actually decline since people would have better access to genuine medicine.

[ludo king]

Thank you for your post, I look for such article along time, today i find it finally. this post give me lots of advise it is very useful for me !

[Alan]

In the resulting full blown market of pseudo-science that would result in such a free for all, how would I know what drug to take for my self-diagnosed illness? Sure, I will still go the doctor and get a professional opinion, but a large percentage of people for financial or for reasons of distrust would not and would turn instead to the internet and the endless snake-oil claims. I think the result would be thousands of people dying because they decided to take an ineffective drug - convinced by hearsay that such and such a drug would cure them, when in reality they were wrong. Again, in a purely Libertarian world maybe this is acceptable because they chose on their own free volition not to seek professional guidance, but l am not sure this is desirable. Not that this means our current system could not be improved.

[N.J.]

Instead 5:45 PM

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*Placebo
*Decoved Akashic
*Pharmacology

internet Rising: a documentary film about virtual connection

https://www.webmd.com/brain/news/20121010/what-are-compounding-pharmacies#1

The Evolution of Psychodynamic Theory with Adam Crabtree
.

Nano-Biosensors could actually replace doctote's algorithms: what happens when algorithms rule?
.
.

https://thenextweb.com/artificial-intelligence/2017/02/27/4-challenges-artificial-intelligence-address/

[scratchg ames]

i think you are wrong. People not do thiss.
Thanks for posst.

[N.J.]

36:11
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11:04 PM
02/09/2018

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