I was preparing some notes for the two essays I hope to write this weekend (which may run a bit late), and I was reminded of one of those topics which has bothered me for some time.

I know that I am not in the Republican mainstream on many issues, especially when I begin to argue on medical matters. Many people are so used to the government meddling in medicine that they cannot conceive of how a fully free market medical system would work. When I say we should do away with licensing of doctors, even die-hard conservatives often gasp and ask me if I am mad. The same when I argue that we should not require prescriptions for any drugs. Oddly enough, even those who want to legalize illicit drugs often seem to think that penicillin and sterile water* should require a prescription, while heroin and cocaine should be sold over the counter.

However, I do think I have one specific topic where even those who disagree with me on the abolition of prescriptions would support me. It is  the argument often advanced by doctors for requiring a prescription for birth control, and, though it is wrapped in a mantle of concern for the patient, it is nothing short of blatant self-interest.

Before I start, let me say that other doctors have suggested that the prescription requirement is there because some women have adverse reactions to birth control pills, but that seems a dubious justification. Doctors preform no tests before prescribing the pill, so what safety is gained by having it prescribed versus just buying it OTC? Some people react badly to shrimp or peanuts, yet we require no prescription for those. If a woman reacted badly to birth control pills, she would either go to her doctor or the ER, whether or not there had been a prescription requirement, so I don't see how requiring a prescription helps make it more safe.

That is not the argument that troubles me though. The argument that worries me is the statement I have heard many times that women need to get a prescription for birth control pills because they "should" see their gynecologist every six months, and the prescription requirement forces them to do so.

Has anyone ever heard a more blatant self-serving statement? In other words, doctors require a prescription because it guarantees them business every six months. Yes, it is worded as being for "their own good", but that is just the pretense. The truth is it is all about repeat business.

Think about it this way: I "should" take my car to the mechanic every 10,000 miles, so should the state only sell me gas if I have a prescription from my mechanic? I "should" see a nutritionist, so should I only be able to buy food if I have a prescription from my dietician? If you say no to either of those, then how do you justify forcing women to see their gynecologist every 6 months just to get birth control pills?

Let us be honest, doctors may pretend it is for the good of the woman, but this particular restriction is nothing but a self-serving law. Even if some gynecologists are sincere, and are not doing it just for the money, it still is a needlessly intrusive law. Who is to say that the gynecologist's judgment of what a woman needs is more valid than her own?** Or, whatever the relative validity, that the gynecologist's judgment should have the force of law?

Now, I do not intend to say that all regulations are similarly self-serving. In fact, the notes I was writing were about the way even honest, well meaning laws often lead to negative outcomes. But, then again, the fact that the prescription laws can be perverted so easily to be used as "make work" for doctors, and that the general public will mindlessly accept even such transparent justifications shows me that the prescription laws, and much of government regulation in general, is quite dangerous. If regulations can be perverted so simply we should be very cautious in providing such opportunities, and should keep our regulations to a minimum.

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* I cannot say whether or not it is still the case, but about a decade ago I suffered second and third degree burns to my hand. The emergency room prescribed a topical antibiotic and suggested I wash it with sterile water after a certain number of days. However, when I asked a pharmacist for sterile water, I was told it was a prescription drug. I cannot attest to the truth or falsehood of this, but the very fact that he could plausibly make such a claim suggests to me that we really need to reconsider the whole prescription drug system.

** Our society seems to have lost sight of a lot of truths in the area of medicine. For example, we often forget that the patient employs the doctor. Many times it appears that the doctor thinks he is in charge, rather than the reverse. Just having greater knowledge does not make anyone any less of an employee. An auto mechanic knows more than his customer, yet we would never give him the power we give doctors.  Some of this is because we have given so many quasi-governmental powers to doctors, from the ability to commit patients to control of access to medications, we have changed doctors from people we pay to heal us to quasi-bureaucrats who we still pay, but then must also appease.

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UPDATED 02/24/2008

This morning I was toying with the idea of moving this article to the "draft" category, until I saw it had garnered one comment. Not that I think it is a particularly bad article, but I was considering whether I really wanted to open the whole subject of prescriptions, medical licensing, and (as it logically follows on this argument) drug legalization. But, as I have already received comments, I suppose I have committed myself, so, rather than post an extensive addendum to this article, I will postpone my two promised articles and write up my rather lengthy (and I am sure controversial) essay on those topics.

I suppose I should add a disclosure to this article as well. My ill health had little to do with my opinion on these matters. I have believed that requiring a prescription for drugs has little safety benefit for some time. The fact that the powers conferred on doctors by prescription laws made my life miserable for quite some time only serves to reinforce this belief. (See my earlier article for a description of my medical experiences.)

Two final points, before I cut myself off so I don't write the entire article in this addendum:

First, I am not abandoning my dedication to federalist solutions. When I say we should eliminate licensing, it is an ideal, not something I would enforce at a federal level. Instead, I would be quite happy to see prescription and licensing laws operate on a state level with NO federal involvement. However, I would fight on a state level to eliminate the licensing and prescription laws, for reasons I will explain above. And, yes, I know some of this is done on the state level now, but, with so much federal control over the states it is far from a state solution, the states often simply enact a model that has proven acceptable to the federal regulators in another state.

Second, just to cut off a possible argument to my brief summary of my next article: Yes, I know doctors can do great harm and provide needed services, but that does not mean we need to have a single, government mandated licensing body. Auto mechanics can kills us as easily as doctors, and provided a needed service, yet we rely upon private certification bodies and trust our own judgment on which mechanic to use. Nor has licensing really worked well in another area, home improvement contractors. In my home state they are HEAVILY regulated and licensed, yet home improvement scams abound, even by licensed contractors, and shoddy building has not been reduced. So, again, it is not obvious that a single governmental (or a government sanctioned private body like the AMA) improves quality at all, and I can show that it is likely to actually prevent some services from being delivered.

Well, as I said, I won't write the entire essay here in the addendum. So please come back in a day or two and read my more complete explanation.