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finally Pharmacologists can write scripts

MobiusDick

MobiusDick

Bluelighter
Joined
Sep 25, 2007
Messages
145
Location
Somewhere in the Eastern United States
I would like to thank all of the states that have allowed pharmacologists to write CII - CV and non-controlled ''dangerous drugs'* Rx's (I use these words in quotes because this is the misdemeanor you would be charged with if you get caught writing your own Rx for say amoxicillin - forgery is also possible in some states)

It is ridiculous for PA's and Nurse Practitioners to be allowed to write for up to CIII's while true experts in how drugs work would have to suggest back to the referring MD, the drugs we recommended when difficult patients were sent to us. We have to be careful we do not cross the line and practice medicine de facto, and we must always have a referral. This seems to get audited a lot lately (note that both the DEA and the FDA are forbidden de jure from practicing medicine, and this is what they are doing de facto by their over-regulation.)

There was a study that came out in 2003 that concluded that iatrogenic (meaning doctor caused) illness kills over 300,000 people in the US each year, making it second only to cigarettes. The study was not including surgical mistakes; most deaths were from poor prescribing practices.

As someone who teaches the physicians of tomorrow, I see this daily. As one of the only professors that refuses to give multiple choice tests, I hear more whining and complaining about this than anything else. There is such a disconnect between pharmacologists and physicians today, that I cannot say if going to a doctor when you are sick is actually safe. Doctors no longer understand pharmaceutical sciences at a level required to practice safe and effective medicine. We should have to approve their prescriptions.

I am in the process of writing a book on this, but here is my advice: GET A SECOND OPINION. And those of you in Canada or the UK, god help you if your doctor won't approve that!

MobiusDick, DVM, PhD, MPH
 
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What states have changed this? I know that the FDA has been considering having a so-called "Behind the Counter" class of drugs that a pharmacist could 'prescribe' like birth control, certain migraine meds, blood pressure drugs, etc- long term things that are fairly safe, but I don't think anything came of it.

Isn't there federal legislation that prevents pharmacists from prescribing except in a small set of circumstances?
 
Many states allow nurse practitioners the authority to prescribe controlled substances from Schedules II-V:

http://www.medscape.com/viewarticle/440315#NY

I anticipate getting an NP license in the next few years and consider my pharmacological knowledge to be of the utmost importance. That said, it's good to know that the experts can now write scripts.
 
Hammilton said:
What states have changed this? I know that the FDA has been considering having a so-called "Behind the Counter" class of drugs that a pharmacist could 'prescribe' like birth control, certain migraine meds, blood pressure drugs, etc- long term things that are fairly safe, but I don't think anything came of it.

Isn't there federal legislation that prevents pharmacists from prescribing except in a small set of circumstances?
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Pharmacologists, not pharmacists. Pharmacists count pills, and pharmacologists study the action of drugs on living things. Over the past two years at least 2 dozen states allow this licensure. I do not have the list handy but I am sure it is available online.

I am not aware of CII's being allowed by NPs but I am not up on this. In my state I believe both PA's and NP's can write for up to CIII's (in fact I know this.) My main issue is the disconnect here between medicine and pharmaceutical sciences and how ill informed todays doctors are. I should retitle the post to stress this.

MobiusDick
 
Well said Mobius! Modern physicians know distressingly little of drug pharmacology.

I suppose if I complete an MD,JD program I will also be able to prescribe drugs...
 
I am a little confused, when do pharmacologists see patients. My understanding was that they generally do research and such. Do I have something wrong here. I just don't know when a pharmacologist has contact w/ patients and thus, I don't know how they would prescribe drugs to people.

Can someone explain this to me.

By the way, this is exciting to me as I am currently an undrgrad hoping to become a pharmacologist.
 
^ i second the above as I too am a little confused as to that

notably MDs largely as I see it simply know how to push drugs Big Pharma pushes them to push with incentives and the like and they know little or care little about true medicine ...probably NPs and PAs are superior as they will compensate by actually caring to learn more and do not have the god complex largely seen in MDs ...obviously this is not all MDs but I venture to say the majority
 
I would rather see a doctor than a pharmacologist. Doctors are skilled in diagnosis. I do not think a pharmacologist should write prescriptions unless they had a medical practice. Why would a pharmacologist need this right? I can see a pharmacist needing to be able to write scripts. Pharmacists are highly educated by the way, and are capable of doing much more than counting pills. In Florida, pharmacists may work with doctors, where a doctor diagnoses, and the pharmacist prescribes medication... then dispenses the meds. A pharmacologist mainly works in the lab, away from patients.
 
Well I think pharmacists are a little more than "pill-counters," their training includes a fair amount of pharmacology and as such they should be in a position to work collaboratively with MD's/NP's/PA's.

I'm not sure how broke the system is, I've never found any MD I've seen to be lacking in the skills necessary to prescribe the pharmaceuticals I've needed, but that's only been my own experience.
 
Well, don't be to quick to judge all pharmacists as just pill counters, most pharmacists begin by having a keen interest and aptitude for pharmacology, it us just sad that many lose the art and just resign themselves to counting pills, but in every pharmacist there is a pharmacologist, however much repressed.
In my former career as a pharmacist I met many people who were very passionate about the science and practice of medicine, not just counting pills, it is all about what you do with the knowledge you have.

That being said, it is true that many pharmacists could care less about psychedelic experiences. It always seemed strange to spend so much time focused just on "physical" diseases and not be more curious about altered states. But that is just me.
 
As much as I agree with the original poster... Just one quick thing. In Canada, there is NO need for 'your doctor' (whatever that means) to approve getting a second opinion. Many specialists will take you without referral if appropriate, and you can always go to just about ANY primary care physician and get them to refer you wherever you need to go (and do it three times over if you want!). Me and a few others were able to 'orchestrate an informal study' for a whole bunch of K users with abdominal discomfort from excessive use into getting CBCs (+ AST/ALT, bili, etc) quite easily. As a result, a specific subpopulation of users (all with the same sources/pipeline) were made aware of liver enzyme elevation and switched their source... just by telling them what to say to the docs. Canadian medical system is pretty much at the whim of the patient if they know what to say/do. Now it does take some inside knowledge to reaaaally make the system your bitch, but not everyone wants to make the taxpayers fund your own research via the healthcare system. Up here is also very much more active/integrated with the research community/universities/medical schools, which I attribute to lack of privatization and commercial interest. Plus, the doctors just 'bill' the government, rather than this whole perception of some government bureaucrat making the last call (like insurance companies can down south).

On an off-topic note... does that mean if I get accepted to the joint MD/PhD program, and go the neuropharmacology route with the PhD research choice, I can just write someone two 'scripts and get the patient charged with double doctoring if they cross me the wrong way :D?
 
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did we ever get a response regarding the question that i seconded above from Beenhead quoted below?...that seems the most topic appropriate question and unless i am in a fog I did not see it answered...


I would rather see a doctor than a pharmacologist. Doctors are skilled in diagnosis. I do not think a pharmacologist should write prescriptions unless they had a medical practice. Why would a pharmacologist need this right? I can see a pharmacist needing to be able to write scripts. Pharmacists are highly educated by the way, and are capable of doing much more than counting pills. In Florida, pharmacists may work with doctors, where a doctor diagnoses, and the pharmacist prescribes medication... then dispenses the meds. A pharmacologist mainly works in the lab, away from patients.
 
I think the point is that while doctors are very skilled in diagnoses they can not always transfer that knowledge into the realm of pharmacological remedies. Take for example the thousands of chronic pain patients who are not properly medicated because of doctors lack of knowledge or fear of opiods. Also there is a good number of doctors who do not support medical marijuana, that is just plain funny because of its stupidity. Once you know you have disease X it would be better for the pharmacologist to decide on the most effacious medication in conjunction with the doctor who could monitor your progress.
 
is that the point?

i still don;t see where pharmacologists are treating people...not that they could not effectively, just where is there a handoff to pharmacologists to do this as what MDs are giving up that aspect of their practice

certainly they would be less likely to have the god-complex and AMA/pharma brainwashing I assume than MDs, but where is this in practice?
 
Pharmacist are probably more suited to that job than pharmacologist, they too undergo a rigorous course of pharmacology, maybe not to the extent of a pharmacologist but is enough to be able to treat patients, and if in doubt can always consult a pharmacologist. However an area of pharmaceutical science that most of people forget is pharmaceutics. Do most pharmacologist/MDs know how to use sophisticated asthma puffers? or know which tablets can be crushed? or if a drug needs to be stored in the fridge? Pharmacist know drugs forms down to their individual ingredients.

Preventing drug related iatrogenic illness is the job of the pharmacist, else doctors would be dispensing and when pharmacologist prescribe, it will again be the pharmacist that double checks before counting those tablets.
Of course pharmacologist would be useful in the checking process, but their scope is limited. And no offense to pharmacologist, but allowing them to prescribe is likely to increase iatrogenic illness since they do not have the clinical skills of other health professionals.
 
LuxEtVeritas said:
is that the point?

but where is this in practice?
Click to expand...

Yes the point is that this new legislation opens up the possibility for it to become a common practice, when before legal limitation made the pharmacologist to patient relationship practically impossible because it lacked financial incentives. Hopefully now people with serious amounts of medication can consult an expert in interaction and efficacy such as the pharmacologist.

And I see no reason why doctors would not want to give this up, as you still need their initial consultation before seeing the pharmacologist. Doctors are never lacking business so now they can get their co-pay for a diagnosis, send you down the hall to their pharmacologist parter who also gets a co-pay, they both get rich, we lose out by paying more for treatment lol.

But really this is a good thing for very sick people who are on tons of meds.
 
^ very good, that makes sense, though i see it taking a long time to be accepted and at all commonplace ,,,and will this be covered by insurance as no one will pay for this I think unless it is...we'll see
 
In my state, and in my case, I generally only see a nurse practitioner, and she has prescribed my C-II drugs before:)
 
damn Op, you make a hell of a good point. I didnt realize the numbers were so high, thats rediculous. I've always wondered why pharmacologists cant write scripts. They're specialists in the medicine they dole, it would only make sense for them to atleast confer with the Dr to work out the best treatment.
 
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