It’s a business question that has bugged me more than almost any other. No, not how do they get the soft center into Caramilk bars, but why are some nonprescription items sold behind the counter in pharmacies?
It is a kind a of Zen-Talmudic questin. Because if a behind-the-counter product doesn’t require a prescription, why do you have to ask the pharmacist for it? It’s not like they’re going to say “No,” are they? And if they are going to say no — if, in other words, it is a prescription-only product — how is that pharmacists are giving out prescriptions? Shouldn’t it be doctors doing that?
This question has bugged me for some time, and I’ve always been puzzled that more people than me weren’t puzzled. Now, however, I have an answer, courtesy of today’s Washington Post:
In addition to being a subject of curiosity for consumers, nonprescription items that are held hostage behind pharmacy counters are hot topics lately in drugstore circles. The collection of items there reflects, in a big way, turmoil that is roiling the pharmacy profession.There is, of course, the huge national, political, professional, women’s rights and religious ruckus that Plan B has kicked up. Plan B is the “morning-after” contraceptive some pharmacists are refusing to stock or fill on religious or moral grounds. It is a massive subject in itself that I will flee here in favor of smaller and less-touchy ones such as . . .
Mucus. As anyone who recently has had a stuffy nose knows, most pharmacies in the Washington area and in more than 30 states have put nonprescription cold tablets containing pseudoephedrine (the active ingredient in nasal decongestants such as Sudafed, Tylenol Cold and Claritin D) behind the pharmacy counter. This is part of an effort to help law enforcement cut down on the manufacture of methamphetamines. Pseudoephedrine is a component of that illegal street drug.
Making customers ask for cold tablets is a good example of a decision that has plusses and minuses for drugstores and pharmacists, says Rob Eder, the editor of Drug Store News.
On one hand, the practice cuts down on theft. Eder says putting items behind a counter and making their purchase obligatory there helps with theft by putting an extra set of eyeballs on them.
On the other hand, the placement creates what retailers call a “barrier to purchase.” You may find it embarrassing to ask for a sitz bath. Or there may be such a long line at the pharmacy that you just skip the stop and go home.
It has, in other words, to do with value-per-unit-mass, quasi-controlled substances, and raw politics. Fascinating.
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Paul,
I think you are working at creating a false dichotomy; drugs should be prescription only or freely available. Consider another example; you can’t buy high blood pressure drugs over the counter. Why not? They are not drugs of abuse. If you are on them, presumably you understand why and continue to take them correctly. Why not simply allow patients to go to the pharmacy (or grocery store) and buy more when needed? Why is there this need to have a prescription? Sure, you should have your blood pressure checked occasionally, but this can be done at home with an automated machine, in the store with one of their machines, or even by a nurse at the doctors office. There is no real need for the doctor beyond the initial consultation.
One of the points of having a “middle ground” between having a drug freely available for self-selection and requiring a prescription is that some guidance is needed in assessing the need for the drug (or other medical intervention), weighing the advantages and disadvantages of the drug, and correctly using the drug.
This, of course, presupposes that the pharmacist actually asks questions rather than simply handing over the drugs demanded.
Nigel — Agreed, there may be a role for a middle ground, but your last point is key: Are pharmacists asking questions, or are they just handing over-the-counter products to customers? My sense, from an admittedly small and personal observation sample size, is that it’s almost always the latter.
If pharmacists want to be considered professionals, they need to be exercising judgement. Else, they can be replaced by machines and minimum wage clerks.