The Public Health Reasons for Monitoring Prescriptions

One of the things that has been revealed by the VA Tech shooting is that the government keeps a database of prescription drug users. This has bothered some. Glenn Greenwald writes (italics mine):

Let me ask you this question: let’s say I come into your office (I’m a mentally competent adult — at least in our hypothetical) and tell you that I want to take a Schedule II drug (or Schedule III) for Medical Problem X (or even just garden-variety insomnia, depression, or anxiety). You tell me that I shouldn’t, that there is a high risk of addiction, that the problem doesn’t warrant that treatment. I tell you that, after listening carefully to everything you have said, I disagree with you and I want to take it anyway.

Why should your judgment prevail over mine for what I take? Why, as a competent adult,
should I need your permission before I can take the substance I decide is best for me?
I ask that, in part, with reference to the attorney-client relationship. Often times in that relationship, there is as much at stake as there is in a doctor-patient relationship — the individual’s life savings, or financial security, or liberty, or even (in the rarest of cases), their life.
Yet the decision about what to do always remains the client’s. The lawyer can advise them, warn them, urge them in the strongest possible terms not to opt for Choice X because Choice X is stupid, self-destructive, risky, irrational, etc. But it is always an advisory role, never a parental role where the lawyer can override the client’s choice for his own interests. Whether to have or listen to a lawyer at all is completely optional. The client can always proceed purely on his own, even in the weightiest of matters.
Why should the doctor have the ability to override the decisions of the patient? Why should the doctor’s permission be required before the patient undergoes the pharmaceutical treatment he chooses? That really makes no sense to me, and for that reason, I am vehemently opposed to these prescription laws.
Beyond all of that, there is even less reason for the Federal government to be monitoring what substances anyone takes. In addition to all the other reasons I listed in the post and commenters have added, I am also convinced — reading around everywhere today on this topic — that there are substantial numbers of people foregoing pharmaceutical treatments that they think they should have (and which even their physicians recommend) because they fear having that information registered in data bases with the government.

Adults have the right to do all sorts of things that other people, including experts in a particular field, think are stupid and self-destructive, even when the person’s livelihood or even life are at stake. That is, more or less, a defining attribute of being an adult.
What is the difference between the attorney-client and doctor-patient relationship, where the former is purely advisory but the latter becomes parental? And other than consumption of medicine which can actually affect the public health (such as excessive consumption of antibiotics), why should an adult be deemed a criminal for using a particular medicine all because a doctor will not give permission for him to do so?

There are two separate issues here:
1) Why does the government know who has been taking what drug? If the government needs to conduct post-marketing surveillance for safety issues (e.g., a potential drug recall), they have to know who has taken the drug. You can’t rely on self-reporting, because that’s a biased sample. To make public health decisions based on bad science is immoral. These data can also be used to determine if a particular treatment is effective (and cost-effective).
The deidentified data (i.e., personal descriptors such as name and date of birth are removed) are used to determine drug use patterns (e.g., age, geographic location, ICD9 codes). Non-scheduled drug purchasing data are used to determine potential disease outbreaks–if everyone suddenly buys Imodium, you know some pathogen is causing a lot of diarrhea (this isn’t hypothetical, the system is in place and is quite useful).
2) Why should doctors get the final say on what to do? The snarky answer is because most people are idiots. In a more serious vein, should we be using limited medical resources, by paying for unneeded prescriptions and adverse medical effects? We can’t demand that doctors care more about patients, and, at the same time, expect them to administer useless or even harmful treatments, particularly when there are consequences to others (even if they’re not as obvious as antibiotic resistance. And kudos to Greenwald for recognizing that–I give love when due…). Most doctors are taught that it’s unethical to administer a treatment with an adverse effect (in the absence of potential gain, obviously). That’s a good thing. (an aside: I would argue that a far greater public health problem than self-denial of medication due to government intrusion is the unwillingness of insurers to approve treatments desired by doctors and patients).
My point isn’t to denigrate the serious civil liberties issues, but simply to note there is more going here than just the perfidy of El Jefe Maximo (yes, the Mad Biologist is saying this. Try not to faint…).

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7 Responses to The Public Health Reasons for Monitoring Prescriptions

  1. natural cynic says:

    A factor that also needs to be considered, and may complicate these issues, is doctor and lawyer shopping. While some doctors will be unwilling to prescribe a certain medicine that you want, there are other docs who might. In the case of lawyers, some may that filing a particular case is foolish a case or use a particular defense, others might be more willing to follow the client’s wishes.

  2. Mark says:

    Regardless of the validity of prescriptions drugs, the analogy to the attorney-client relationship is way off base. The relationships are entirely different.

  3. bigTom says:

    A supposedly unsmall (perhaps Mike knows the details) number of people die from taking multiple drugs with serious interactions. Especially if these people are using more than one doctor and pharmacy, if would be rather nice if they could be alerted before it is too late.

  4. Jeb, FCD says:

    I would love to hear of a lawyer telling a client, “No, I will not let you pursue whatever course of action is detrimental because your health/well-being/sanity could be endangered and open me to the possibility of having legal action taken against me which could jeopardize the rest of my career and/or drive up my malpractice premiums.”
    But, we live a world not driven by reason or logic.

  5. whig says:

    How would you propose to regulate medical marijuana, would you keep such a federal database and would you expect compliance?

  6. Definately some food for thought in this post considering the reaction of most of the left on this issue.
    As to your answer to question #1:
    Are you sure they are only using it for “post-marketing surveillance for safety issues”?
    Given the proven track record of this bush administration – you can rely on them to be unethical given every opportunity – I can see them using the info for the industries marketing purposes, or to help cover up issues, or to play political blackmail, etc., before they ever consider using it for the more ethical purposes it should be used for.
    But I am certain many would share this low level of expectations concerning the bush administration by now…

  7. sailor says:

    The patient driven drug demand would be less of a problem if the drug companies did not spend more money on advertising than they do on research.

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