The Corner

Why So Many Prescriptions?

I have long suspected that the reason quite so many medicines are only available on prescription owes more to the instincts of the nanny state and the needs of the physician’s wallet than any real concern for health care or safety.  

Writing in the Financial Times, Gillian Tett looks at one example, Mylan’s EpiPen, “a retractable syringe that administers epinephrine to anyone suffering a severe allergic reaction.” Tett relates how Mylan’s CEO had (to be sure, not only for altruistic motives), an “ah-ha!” moment when she saw the defibrillator stations at Disneyland;

[Like defibrillators, EpiPens] only work if they are used quickly, so why not have anti-allergy devices placed everywhere, ready for easy use if a child reacts to nuts, a bee sting or anything else?

Yes, it’s for the children, but this time it really is, and the government response has been telling:

The issue at stake revolves around the degree to which the US government is willing to let its citizens buy and administer life-saving medicine without state controls. At first glance, the EpiPen might look like a device that conforms perfectly to libertarian ideals. It is deliberately designed to be simple enough for even a child to use unaided (it is based on a kit created by the US military in the 1960s to enable soldiers to inject themselves against nerve agent poisoning). And the dose of epinephrine – or adrenaline – dispensed by the EpiPen is so small that, while it is enough to halt allergic reactions, the only likely side effect is a raised heartbeat.

Nevertheless, when the device went on the market a few years ago, US regulators stipulated that it could only be made available on prescription and administered to a specific patient. Officially, this is to prevent abuse and curb side effects. However, some citizen groups blame it on the conservative, protectionist instincts of the medical profession.

Probably, plus that whole nanny state thing . . .

And the consequences?

Only around 7 per cent of the people who are at risk of an allergic reaction are now thought to hold EpiPens, either because they have never bothered to get a prescription, were unaware of their risk, or could not afford the $100 price-tag. And even people who have prescriptions sometimes leave their EpiPens behind.

Earlier this year a seven-year-old girl in Virginia went into shock when she ate a peanut during a school break. Although the school held EpiPens for other children, it was not allowed to administer one to her, since she was not “named” on any of the prescriptions. Tragically, the child died. And this is not an isolated case: around 1,500 people are thought to die in America each year from similar allergic reactions which could have been reversed with an EpiPen.

Some change is now underway. Last year, the Illinois Senate passed a law which permits schools to stock EpiPens, and some other states are considering doing the same. Two senators – Dick Durbin and Mark Kirk – are pushing a bipartisan federal bill, too.

Faster please. 


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