The Right of Self-Care
Friday, March 4, 2011 at 12:26PM Daniel MacArthur has a good critique of a letter that the AMA sent to the FDA, asking the latter to give physicians a monopoly over the interpretation of genetic counseling.
This highlights an interesting and relatively under-explored problem. Critics of the medical monopoly usually focus on its effect on other health practitioners, like nurses and midwives. But the combination of medical licensing and the prescription system has another equally significant effect: people are outlawed from treating their own medical conditions.
It is hard to think of any other good or service that it is illegal for people to supply to themselves. Many people go out to eat, but it is legal to cook at home (and to grow plants for ingredients). One can pay an accountant, or do the taxes himself/herself. No one can legally stop me from building my own computer. In the case of schooling, which is mandated, people have the option of homeschooling. We are even allowed to represent ourselves in our own trials.
Yet if I use the widely available DSM criteria to diagnose myself with Major Depressive Disorder, I am not allowed to buy an SSRI and try it without a prescription from a physician. If I have diabetes that has been controlled with Metformin for 2 years, I am not allowed to continue treating myself with this medication without a doctor’s approval.
The right to do things ourselves is important, both because it is an essential freedom and because it adds another level to the competition that all industries face, limiting the ability to charge excessively high prices. I have never made a pizza, but I would if stores started charging $200 a slice. It also ensures a minimal level of quality. I would not pay to see a lawyer for an hour unless he can provide me with more information than I can get in an hour from the internet. It doesn’t really matter that few of us exercise the option to do these things ourselves. What matters is that we can. The fact that few of us do is good evidence that we get more value by buying these goods and services than by providing them for ourselves. The suppliers of these goods and services have won the competition against self-provision (of pizza, computers, etc.)
But doctors cannot claim to have won the competition against self-care. This is because, although they do have to compete against each other, they do not have to compete against self-care at all. (And now the individual mandate, to the extent that it is enforced, means that health insurance companies no longer have to compete against self-insurance.)
Historian Paul Starr makes a good case that doctors initially obtained this privilege by convincing a sufficient number of Americans that there were certain things that only doctors could do. One can see how that was possible in the 19th century, when scientific advances had significantly widened the knowledge gap between the educated and the laymen, and when many fewer people were educated. But today, with the help of the internet, the gap is narrowing. Patients are learning about their own conditions, reading about the latest scientific advances, and sometimes can have more knowledge in specific areas than do their physicians.
So it is time to question the legal limits on self-care. It should no longer be possible for physicians to deprive individuals of the right to take care of their own medical problems, if they choose to do so.
This is not just a lofty claim. There are at least a few types of cases when NOT going to the doctor might be reasonable, and could save a lot of money, particularly for those people who are savvy about reading medical information online:
- People who have been taking the same medication for a period of time and don’t expect any changes in the near future. An example: a young girl who takes an oral contraceptive.
- When a patient knows more about something than does his doctor. Genetic counseling can be a good example.
- Repeated attacks of the same illness. For example, someone with gout who has been treated with colchicine can learn to recognize and treat the flare-ups.
- Treatment of early stages of chronic illnesses like high blood pressure and high cholesterol, and even diabetes. This is certainly far away from current practice, but I see no reason why a savvy patient with elevated cholesterol can’t modify his own diet, take a statin, and get blood tests regularly at a local lab.
With regard to the last case, chronic diseases account for 47% of health care costs in the U.S., so self-care could help reduce health care costs. Certainly in all of these cases, self-care would free up doctors to take care of more sick patients. Given the shortage of physicians in the U.S., I’d rather have more people engaging in self-care than have the sick wait to see a doctor.
Of course, all people should still have the option to see a physician for advice. But having the option to take care of ourselves would at least require doctors, like all other service providers, to convince potential customers of the value of their services.
Reader Comments (25)
There is an additional problem that arises from denying people the right to self-care using traditional, or allopathic medicine. They resort to homeopathy and other alternative medicines that could potentially be even more dangerous.
Let's elaborate on your gout example. I assume colchicine has been widely tested and proven to work. If a doctor has previously prescribed it, then it is safe to assume that the chronic patient is familiar with the side effects. It is also probably safe to assume that he can find reliable scientific information about this online--anything from drug facts listed by the pharmaceutical company, to presumably responsible posts about it by the NIH. As you imply, it is probably not that risky for this patient to just skip the visit to the doctor next time he suffers a flare-up, and just go straight to the pharmacy.
However, since he's not allowed to do that, a patient who is tired of paying a doctor to tell him something he already knows, might try something different. It could be something as seemingly harmless as this website's advice: "For an acute attack, there is no better remedy than a fast of orange juice and water." But he could also stumble across this site, which suggests he take an herb called Bromelain.
As with most herbal remedies, there's a lot that we don't know about Bromelain. The NIH say's it's "possibly safe" in "appropriate amounts," but they don't tell you what an appropriate amount is. They also warn that you need to be cautious when taking it in combination with medications as common as aspirin.
So in a way, the option to self-care remains. The current system just makes it more dangerous than it needs to be.
Thanks Dr. Liberty - Extremism may not vice in defense of liberty, but I think your post raises some important questions about routine medical practices for follow-up care on chronic disease, even if we take a less extreme stance. All too many office visits boil down to getting a prescription refilled, which generates a billable moment and fits into the production schedule of the 11 min visit. But if this is all that it does it is a waste. Perhaps the refill should be done over the phone/IT system (with patient-consumer reporting relevant vitals, treatment effects, symptoms, and side effects) and the visit reserved for something that merits a face-to-face.
LOVE farro. Have you looked into Ferriss Organics in Eaton Rapids? No farro but they've got some lovely spelt and other great flours!-cool Versace eyeglasses
It`s hard to imagine that a natural grow homeopathic remedy could produce side-effects to such extent,
Pretty good article.I just came across your site and wanted to say that I have really enjoyed reading your blog posts. omega constellation watchesAny way I’ll be coming back and I hope you post again soon.thanks for sharing. replica rolex
Carnegie's cheap nikes shoescourse is in get athletic nike shoe saleincreasing
reputably discount christian louboutin while, brand new jordan shoesalso
appeared all hot pink nikessorts of mbt shoes discontinuedcriticism. In
controversy, nike high top dunkscarnegie athletic nike shoe saleleft the
classroom new nike shoes 2010of Y.m.c.a. , established discount mbt shoesCarnegie in
cogitative vibram five fingers salesepigenesis mbt shoes clearancecurricular
company, begin new nike shoes 2011tuitionaldiscount mbt shoes unique at that time
Carnegie hot pink and black nikescourse. Carnegie new air jordanscourse continued
the tenet that the cheap christian louboutinsadult teachs a class before him, ask each student wants mouth conversation on
classroom, must have impromptu speech.
What's even more satisfying to do great things for decent people need.Despite the basic reality that the organization generates a lot of Ugg Boots UK, buy and, of course, they are very popular as shoes for the diagnosis of relaxation. Create robust and can withstand a good case could probably especially Ugg extended
Uggs Outlet Store you can choice the shoe sfor you on the winter
Moncler Outlet is good for you on winter if you have the Moncler
Uggs Clearance so individuals finds intricate to locate the awesome Ugg boots outlet
Ugg Boots Clearance Sale are you like ugg shoes
uggs clearance
moncler clearance
cheap moncler
moncler outlet
uggs clearance
uggs clearance
moncler online shop
uggs clearance
uggs sale
moncler uk
uggs boots on sale
moncler uk sale
cheap uggs sale
moncler uk store
Cheap Moncler Online，uggs clearance，is very modest,because the discountuggs clearance,can help you grasp the beauty of a woman's eye,you collect a lot of online Moncler Boots,your whole world seems warm and stylish.In the winter,Womens Moncler always seize the audience's attention,there is no beautiful style,both warm and comfortable,classic. Moncler online Therefore,the soft winter fashion discount uggs clearance become the first choice and a single product.Moncler 2011 will not let you down for sure. Our Moncler Outlet Store presents many uggs clearance, uggs clearance,different products.
Cheap Moncler Online，uggs clearance，is very modest,because the discountuggs clearance,can help you grasp the beauty of a woman's eye,you collect a lot of online Moncler Boots,your whole world seems warm and stylish.In the winter,Womens Moncler always seize the audience's attention,there is no beautiful style,both warm and comfortable,classic. Moncler online Therefore,the soft winter fashion discount uggs clearance become the first choice and a single product.uggs On clearance,
Moncler 2011 will not let you down for sure. Our Moncler Outlet Store presents many uggs clearance, uggs clearance,different products.
Welcome to Moncler Jackets Shop! The biggest catch with winter wear is they turn out making you search like a teddy bear at the value of remaining warm. moncler outlet The Moncler jacket is a flattering jacket to possess inside your closet whether or not it really
is a thing you may not have the ability to put on for all time. moncler online shop The styles and colours that Moncler Jackets have are assorted but there need to be just one for almost any person. moncler outlet Moncler jackets will not be just warm but are effectively in form and trendy to boot. moncler outlet Moncler Outlet are here to offer ideal winter protection and present you with a debonair search. buy uggs online No need to compromise on how you look so that you can remain warm.
moncler jackets what are you waiting for, discount ugg boots choose the Moncler Online from Here! Get the warm feeling with them now!
In winter, <h1>uggs outlet<h1>, without doubt, <h1>ugg bailey button triplet<h1> is one of the most well-known shoes. The cold season of 2011 will bring this item with versions to suit all tastes <h1>uggs for cheap<h1>.
The <h1>cheap ugg boots<h1> are going to become IN this season.
Do you like this form of boots?
Which do you prefer? The rough hard boots which you could kick some zombie butt in. Or the beautiful delicateness of <h1>ugg sheepskin cuff<h1> that bring you a
little feminine touch. I want to hear everyone's opinion. I like currently being ready to defend myself that's why i love my fight boots i got from
an wonderful <h1>ugg boots sale<h1> store.
Ankle boots are at present my favorite varieties of footwear.
As it is possible to see in <h1>ugg boots sale uk<h1>, celebrities like: Erin Wasson, Kate Moss, Nicole Richie, and Jessica Alba have been rocking this type,
<h1>uggs on sale<h1> are going to be quite "in-stlye" this fall and also winter.
So do you like ankle boots for <h1>ugg boots clearance<h1>?
Are they a hit or miss for you?
I produced this look on <h1>ugg boots outlet<h1> and attempted to create two appears with just one particular dress by styling it in distinct methods.
<h1>louis vuitton outlet<h1> is an incredibly cute but additionally sophisticated <h1>louis vuitton<h1> dress simultaneously and also the coral color is simply remarkable!
The first look is a single you may put on to function when you like a more fashionable <h1>louis vuitton neverfull<h1> for working. I utilized the dress as a base then added a
brown leather biker <h1>the north face<h1> jacket, a washed off brown jegging and some brown ankle boots with straps in <h1>the north face outlet<h1>.
The UGG classic boots outlet is an astounding hit, even on this tag of currently being 'ugly'. People love most of these Women’s UGG 5815 Tall boots because not any other boots can provide the amount of warmth these shoes provide. They come in lots of unique colors, designs in addition to styles. UGG classic boots outlet stores are difficult and keeping them in account considering that the range available intended for these UGG classic boots is really amazing.
No matter what your best color is or what your best design is you might surely find a couple UGG boots outlet sale that can suit you. Intended for men, the UGG boots outlet stores are essentially basic and with classic styles. For women, however, there are truly many choices. Women love to help wear different pairs of Hot UGG Classic 5815 Tall boots in addition to boots with unique dresses and the UGG boots outlet on sale gives to them that choice.
Likewise, women can invest in the UGG boots UK sale in most different styles. You can acquire the UGGs boots UK outlet which might be ankle high or things that reach mid-calf. Team UGG 5825 Classic Short bootsthat has a short tight skirt and you should look unbelievably sizzling. UGG boots UK clearance outlet make an incredible combination with lots of jeans as very well.
If you want to visit to any casual occasion and don't really have any time to dress UGGs online outlet in place, all you need to do is wear some sort of skinny jeans and two of the UGG Classic Short boots 5825 and you will be the center of attraction for the party. Smell this UGG Classic Tall boots 5815. If people sense any color or dye stench, then the UGGs online shop discount are often fake.
UGG Australia sale UK
UGG 1873 Bailey Button Triplet
UGGs Australia UK
UGG Australia sale
UGG sale UK UGG Australia sale UK online
UGG clearance UGG boots sale
<p align="left">This article is from http://www.uggsonlineoutletshop.com/.</p>
<h1>ugg bailey button sale<h1>
<h1>ugg bailey button chestnut<h1>
<h1>ugg classic tall sale<h1>
<h1>ugg classic tall grey<h1>
<h1>ugg classic short sale<h1>
<h1>ugg classic short grey<h1>
<h1>ugg classic tall sale<h1>
<h1>ugg classic tall navy<h1>
<h1>ugg classic short sale<h1>
<h1>ugg classic short black<h1>
<h1>ugg bailey button bomber<h1>
<h1>ugg bailey button bomber<h1>
<h1>ugg classic cardy sale<h1>
<h1>ugg boots sale<h1>
<h1>ugg classic cardy sale<h1>
<h1>ugg classic cardy black<h1>
<h1>ugg bailey button triplet sale<h1>
<h1>uggs outlet<h1>
<h1>ugg bailey button triplet<h1>
<h1>ugg boots sale uk<h1>
<h1>ugg boots sale uk<h1>
<h1>louis vuitton outlet<h1>
<h1>the north face outlet<h1>
<h1>uggs for cheap<h1>
<h1>uggs on sale<h1>
<h1>ugg boots sale<h1>
<h1>uggs on sale<h1>
<h1>ugg boots outlet<h1>
<h1>ugg boots clearance<h1>
<h1>ugg boots sale<h1>
<h1>cheap ugg boots<h1>
<h1>ugg for cheap<h1>
<h1>ugg boots outlet<h1>
<h1>uggs outlet<h1>
<h1>uggs outlet<h1>
<h1>uggs for cheap<h1>
<h1>uggs for cheap<h1>
<h1>ugg boots sale<h1>
<h1>ugg boots sale uk<h1>
<h1>uggs on sale<h1>
<h1>ugg boots clearance<h1>
<h1>ugg boots clearance<h1>
<h1>ugg boots outlet<h1>
<h1>ugg boots sale<h1>
<h1>louis vuitton outlet<h1>
<h1>coach purse outlet<h1>
<h1>coach purses outlet<h1>
<h1>coach purse<h1>
<h1>coach purses<h1>
<h1>cheap coach purses<h1>
<h1>coach outlet store online<h1>
moncler jackets
ugg boots for women
monster beats
wedding dresses
chi flat iron
An dieser Stelle ein Motorrad Taxifahrer den Menschen helfen, Kontakt 1 Caiyi Deng hat keine Genehmigung für das versprechen wir durch die Zeit des Baches, viele, um die Kosten für viele. Anschlie?end verschieben ugg Schuhe Ger?t ein Mitgliedsverband prost, billige uggs Steckdose, Cai Yideng 9 und segelte eine 3 Mann Bereich insgesamt 12 friedfertige Menschen begeben, Christian Louboutin Replik, kostengünstige uggs Parkplatz der Bus-Gate w?hrend turnin, wandte sich nahezu und fuhren in Richtung Süden des Yangtze.
Das Feld ist bereit zur Umkehr zu Waffenruhe ?ffnen, wenn pl?tzlich ein kleines Holzboot umgeworfen, der Bogen aufgeteilt in mehrere Teile, fiel alle 12 Menschen an Bord ins Wasser. noch einen Blick von Panik.(ugg boots deutschland)
Chang Kleinbus apt der Stadt Fengjie Qutang Dorf Bai Di Vater, feiern Yang Xiaolin Freunden 70. Geburtstag.
obwohl, sehen andere Menschen haben Alarm enthalten ist, und Cai Yi Fan Shen ertrinken Menschen k?mpfen, um zu den anderen schwimmen zu emanzipieren.
(ugg boots sale)
Wanzhou Reporter Journalist Station Korrespondent Huang Jinhua Zhang Xingmao Fotoreportagen
ugg boots billig
ugg boots
Unsere Philosophie:
verkauft UGGs Stiefel zu günstigen Preisen. Unser Ziel ist es, unsere Kunden mitden weltbesten UGG Artikel zu einem hervorragenden Wert liefern. Siemayalways finden ein luxuriöses ein, dass Ihre Augen fangen kann, bleibt die Tatsache, dass der Preis wettbewerbsfähig ist. Wir sind ein professionellesRabatt Uggs Online Store exprienced im Umgang in UGGs Stiefel. Unser RabattUggs Online Store sind Sie genau auf alle Arten von uggs Stiefel bezahlt undstellen Sie sicher, sie können unsere Kunden den hohen Anforderungen gerecht zu werden. Als unser UGG Artikel passen Sie Ihr Budget als auch Ihrem Geschmack, Join us.
Tag:
ugg boots sale
ugg boots
ugg boots kaufen billig
ugg boots deutschland
Cheap UGGS For Sale
Cheap UGGS Online
UGGS For Sale
Hey man Very inspiring article. basicall,I am a .Net programmer. But earlier I I wanted to be a system programmer. But I could not succeeded in that field. When I read this article It inspire me about system programming. Please provide me good site where I could read such articles. zaioba zaioba - Jimmy Choo Chaussures.
application software
system software
cheap software
oem software
Adobe Creative Suite CS5.5 Design Premium
Adobe Creative Suite CS5.5 Master Collection
Microsoft product key
Adobe serial number
Coach Factory Outlet
are meant to Coach Factory Online
with their Coach Outlet
to enable Coach Outlet Online Store
to underxvvxcvstand and perform Coach Factory Store
. For a coach to be able to bring about good Coach Outlet Store Online
, it is important for Coach Factory Store
to be provided Coach Outlet
training and Burberry Outlet
. It is also Coach Outlet Online
for Coach Factory Outlet Online
to share both professional and Coach Outlet Store
details to acquire the best Coach Outlets
. The approach ought to be Coach Factory
about self-discovery, rather than Coach Online Factory Store
performance. Hence, Coach Outlet Store Online
of performance along with personal Coach Factory Online Sale
should be the priority. Coach Factory
plays an Coach Factory
role in Coach Factory Outlet Online
this as the Coach Factory Outlet Online
is based on Coach Factory Store Online
a person in the right Coach Factory Online
instead of providing a list of Coach Factory Store Online
that need to be achieved. Performance Coach Outlet Online Store
can be effective only when a Coach Factory Online
is guided towards it. Coach Factory Outlet
can help you lead your life in a Coach Factory Store Online
manner.
When Louis Vuitton Purses
is weighed against Coach Factory Store Online
, coach mentoring carries more Coach Outlet Stores Online
. Supervision alone cannot deliver the desired Burberry Scarf
. Supervision is limited to the process of overseeing the Coach Store Online
. Whereas, to improve the quality of Louis Vuitton Bags
, proper mentoring is also Coach Factory
, because it ensures development on the professional Coach Factory Online and provides external support.