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Our role is to identify the correct medication, tell you what you need to know about it (which is later reinforced by the pharmacist), check in with you to make sure you are still doing as instructed, and so on.
Many medications are very dangerous if taken incautiously - TB drugs require a lot of instructions and very careful compliance for instance. Low dose Lithium is extremely safe but can easily interact with other medications, cause significant side effects, or cause problems in response to athletic activity and dehydration.
Some medications have side effects that will very rapidly kill you that are rare enough patients wouldn't think of them....the list goes on.
I'm sure all of that is very helpful to many people, but we're not talking about banning doctors. Remember, we are not stuck with just two possibilities of "banned" and "mandatory". For many, could you not just have massive warning labels that say, "This product is meant to treat specific conditions in specific ways; please consult a medical expert before use," in case someone has difficulty identifying the correct medication? They could still be sold by pharmacists, who can inform you of what you need to know about it (as they already do). If you show any uncertainty, they can say, "If you don't know, you should contact a doctor." The checking in sounds mostly paternalistic, basically just a verbal reminder; what's the real point here if you're not physically making sure they're doing as instructed?
Because remember, you're not actually making sure that they're not taking the medication incautiously. You're not actually going into their home and dispensing a precise dose at a precise time. You're an occasional verbal reminder that they need to comply with the instructions on the package of the TB drugs, another set of eyes to check if there are other medications that might interact. You're not actually stopping them from doing something dangerous.
What do you actually do about that?
EDIT: The warning label can even say, "This product is dangerous if not used correctly," or even, "This product is dangerous even if used correctly," with another recommendation to consult a medical professional.
It's important to understand that medical stuff is more complicated than a layman is likely to understand, you see a lot of minimizing and belittling of the knowledge base of doctors these days and it leads to people not respecting the depth of complexity here. We do ourselves no favors in the process.
Consider a Statin. The benefits are pretty big...sometimes. But there isn't a lot of consensus as to who to give it and when. you have complex questions like "what number of rare debilitating side effects are appropriate for a moderate decrease in population risk. If you prevent 10 MIs is that worth one 30 year old getting an autoimmune issue and being unable to walk? What about 20? What about 50? What about 100? What do you do if the Family Med and Cardiology organizations disagree over what to do?
Medicine is both an art and a science and often lacks consensus. Standard of care is fuzzy and constantly being revised. We have to do ongoing education throughout our entire careers because a recommendation that was present from day one of my medical school is suddenly known to be wrong. Or maybe not, I have to read the paper and check.
Patients are not equipped to handle these considerations and don't realize how REAL they can be. We know patients will injure themselves or get themselves killed with poor decisions if left to their own devices so it's our job not to. Sketchy hormone replacement (testosterone), overprescription of stimulants and benzos, poor antibiotic stewardship...patients will do their best to do what feel is right with zero information and this can be extremely harmful to others or society (in the form of unnecessary medical costs and care).
You see a lack of consensus and a range of suggestions and think that this means that you must have an individual artisan. I see that and think, "Seems like there's kind of a range where most of the time, people will probably be okay-ish, so long as they're doing something plausibly in that range." At least until we have a more clear consensus. They can still go get advice, and if so, they'll get whatever doctor they trust, who thinks they should be in whatever part of that range. That's not killing them (at least not enough to form a clear consensus yet).
The rest of this is pretty much just paternalism. Like, I get it, many car owners are not equipped to handle the various minute considerations and the art of
motorcyclecar maintenance. We know car owners will injure themselves or get killed with poor decisions if left to their own devices (the number of bozos who get underneath a car that's just on a hydraulic floor jack, SMH; or maybe they'll screw up a brake bleed procedure and have a massive braking failure on the highway, etc.). But we don't ban it. Millions and millions of people still go to car repair experts, because they know they have zero knowledge. We don't ban auto repair experts, either! Sure, some people spend too much money on silly aftermarket turbos or whatever, and some of them even screw it up and blow up an engine, possibly causing death. But imagine if we took that and decided to ban people from buying their own car parts; do you think that "unnecessary car repair costs" (including the new cost of being required to go to a professional for literally every little thing) would decrease?!? I honestly do not have any idea what possible model of economics you could be using to get to this result.I think the rate of self-injury from maintaining a car yourself would be quite a bit lower than the rate of self-injury from deciding on one's own medical treatment, and that's the reason for the different kinds of regulation.
Would it? Most of the time, when industry advocates are here arguing this sort of point, they're implicitly assuming that the use of medical professionals will drop to zero (or be banned). Thus, they're imagining the least knowledgeable person deciding on their own medical treatment. But when we look at the car maintenance world, we see the vast vast majority of low-knowledge folks still using automotive professionals. The rate of self-injury is, indeed, low, but someone needs a bit more than arguments from bad imagination if they're going to rest on a claim that the rate of self-injury would surely be "quite a bit" higher.
You hear this same shit from the realtor cartel, and frankly, any cartel that wants to maintain its market power. "Oh real estate transactions are so complicated; can you imagine how the sky would fall if we didn't get our 3% cut of every transaction?! PEOPLE WOULD BE HARMED!" You know what really would happen if you lost some of the sketchier tools to maintain your market control? First, you'd probably have to clean up your act, but second, lots and lots of people would still use you, but for your actual expertise, rather than because they think they're basically forced into it. Sure, will there be some harm that didn't occur before? Probably. But there's some harm now that wouldn't occur then, too. You need an actual argument about magnitudes rather than just imagination.
EDIT: Remember when it was every state, rather than just two states, who banned you from pumping your own gas into your car? Surely there were folks saying how risky and dangerous it would be (gasoline is flammable, don'cha'kno?) to let ignoramus individuals do it. How's that argument looking for those two states that have held on to it?
My argument is we can see how huge and insane the supplement and alternative medicine industries are, and it's good they're not allowed to use medications that actually have effects, because then they'd actually hurt people instead of just being placebos.
I don't see how you can make that conclusion. People currently take a variety of things that don't hurt them; therefore, they will take huge and insane amounts of stuff that hurts them if we let them?
Imagine that we did ban personal auto repair. You have to draw the line somewhere, so there's some unregulated space where people could go ahead and buy, like, bumper stickers, stuff that hangs down from their rear view mirror, or even vortex generators. And someone observed that folks do a bunch of stuff with their car that is stupid and doesn't provably help the car go faster, run longer, or get better fuel economy. They then conclude that it would be a disaster if we stopped banning personal auto repair, because that obviously implies that masses and masses of people would severely hurt themselves. Why couldn't we end up with the world we have now, where most people still just take their car to a professional, but some do it themselves? Yes, some people hurt themselves doing it themselves, but I don't see why we should have concluded that it would be a huge, mammoth disaster.
I would note that I think there's probably a significant difference between a label that says, "These claims about being vaguely good for your hair health or whatever are not evaluated by the FDA," while still being cognizant that the product has been evaluated for safety... and a label that says, "This product will seriously harm or kill you if taken improperly; please consult a medical professional."
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We require people to get car insurance because we know they will make the wrong decision (not getting insurance) if left to their own devices. Some people try this anyway.
We know that people will make the wrong decision with medicine also. Some of this is objective - people would prescribe themselves substances that are controlled (for a reason, for instance opiates), people will ask for treatments where the benefits are clearly outweighed by the risks. Consider all the people who use marijuana when they clearly are not supposed to,* or try and get Addy as a performance enhancing drug, or use illegal substances. What do you think would happen if you could just Dilaudid at the pharmacy? It would be a catastrophe.
The classic non drugs of abuse example is antibiotics. People will ask for antibiotics every time they get sick. Even when it's clearly viral and therefore the abx won't help. They will demand abx, they will write reviews complaining about it and bully the prescriber into giving them abx - even though they won't do anything helpful. Zero benefit.
And the costs can be high to the individual (side effects can be very bad), and to society (antibiotic resistance is increasing greatly). If someone becomes disabled because they took an abx of their own recognize society will pay the cost. This is not theoretical, people kill their kidneys with NSAIDs for example (that's OTC).
If left to their own devices patients will make objectively shitty decisions. The regulatory state exists to prevent this, you don't want people on the road without insurance.
When it comes to the more subjective stuff it does get a bit fuzzier but the fundamental problem remains, no layman has the knowledge and experience to make these judgements, just googling a pubmed article is not enough, smart and educated people think they can figure it out but this requires training and experience. The average person has no chance and society needs to be organized around protecting average and below average people.
The regulatory state has its problems but we require building codes because people will elect to live in a poorly built slum if given the choice because it's cheap. We have to protect people from themselves.
People will take a gamble on "it's fine I have a 1% change of a bad side effect from this antibiotic but society will pay the cost and even though this infection is viral maybe its not."
This is stupid.
People do not like being told what they can do and put in their bodies, but little in the world is as important to get correct as human lives. I remember what it was like before I was a doctor, I thought I knew what I was doing I did not.
*I'm not saying nobody is allowed marijuana, it's complicated.
What type of car insurance do we require people buy? Hint: it's not the type that compensates them if they screw up their own car. It's for a different purpose. What do you think that is?
Most of the rest of your comment appears to be just additional restatements of the things I've already responded to. Yes, car owners lack knowledge, and they'll make mistakes sometimes when they don't use the services of a professional. I don't see where you've made any further advancement on the argument.
I do think that this part is a slight refinement. At least one that I only obliquely addressed, not directly. When it comes to the subjective parts of auto repair, it gets fuzzier, but the fundamental problem remains. Laymen aren't going to have the knowledge and expertise to make those judgments, and the Chilton guide isn't enough, either. They need training and experience. Average person has no chance... of that last few percent that is still probably within the realm of the basic guidance where there might not even be a consensus, anyway.
This is just tripling down on paternalism, and it's one that is soundly rejected in most rationalist spaces. YIMBY is currently reigning supreme, haven't you heard?
People don't like being told what they can/can't put in their cars, but nothing is more important than thousands of pounds of steel hurling down the road at high speed, where lives are at stake. We can't possibly let people work on their own cars. ...or at least, that's the conclusion of your logic.
If you are okay with putting a bullet in the head of anyone who uses medical care without expert opinion in any way that causes a societal cost then sure.
But we don't do that.
If you become disabled, or end up on dialysis, or increase the risk of a multi drug resistant organism other people subsidize you.
The cost with which we subsidize you is immense. Hundreds of thousands to millions of dollars per person. Society cannot afford to pay that more than necessary, and ethics prevent us from euthanizing people for their ineptitude.
Paternalism is good to some extent it's why we have building codes and financial regulations and you know....laws. Where you draw the line is a point of discussion but drug libertarians don't know anything about medicine and have zero idea what they don't know.
This is a wildly disproportionate and frankly bizarre thing to say. We could just not do that. Or are we currently required to be okay with putting a bullet in the head of anyone who works on their car without expert opinion in any way that causes a societal cost?
But let's be clear what you're doing here. You've become unable to defend your previous position that would imply that we must ban individuals from performing auto repair, so you're playing a two-part threat. Claiming that we must restrict supply because we've subsidized demand. It's a lucrative hustle in crony capitalism if you can control the government in this way. But we can easily dismantle the threat, cut the Gordian knot, and just not do any of that stuff. Just stop. Stop putting bullets in people's heads. Stop making everything either banned or mandatory.
This is completely absurd. If we have any law, we must have one particular set of laws that benefit your industry. Just utterly disconnected from reality. This sort of reasoning can justify literally any regulation, no matter how insanely stupid, no matter how insanely destructive, no matter how insanely corrupt. "What? You want no laws whatsoever?" Come on. Be serious.
You are advocating for people to do what they want and have others pay for their failure. People taking over their medical care without professional supervision directly hurts others and themselves, and society literally pays for it in terms of opportunity costs and DIRECT costs.
I haven't seen you engage with any of the examples I've given or actual content at play, just give a metaphor which is poor and repeatedly express your stance.
When given the ability to hang themselves in healthcare people do so. This is not a hypothetical. This is true right now and I gave examples, and that's for the simpler things.
If you want to continue this conversation please explain what antibiotic stewardship and why it's important, or argue why it isn't.
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Specifically, though, people are forced to get third party liability insurance, because there the costs of their wrong decisions is very much borne by others (the argument could be made that ultimately wrong medical decisions could end up like that, but it's a greyer matter).
Antibiotic stewardship is something that impacts others, but the bigger problem is that people will ignore their own health as much as possible and then society pays the costs by caring for them after their mistakes. With obesity and some other lifestyle things accept this because you do need to limit how much you impact people's rights, but throttling of medical care is almost universally considered reasonable due the complexity in making informed decisions.
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