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Notebook Medicine

Physicians with prescriptions

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Medicine

Physicians with prescriptions

As demand surges for drugs that could fight the coronavirus, some doctors are purchasing them—for themselves. Is that ethical?

When vital medications are scarce, should doctors and medical workers get first dibs? A recent New York Times article highlighted state efforts to conserve the supply of drugs that could prove effective against the novel coronavirus—mainly hydroxychloroquine, an anti-malarial drug I wrote about last week. Amid speculation the drug could reduce the severity of COVID-19, states have noticed a sudden increase in doctors prescribing that and other medications for themselves, presumably while they are not yet sick.

Most readers commenting on the Times article frowned on the idea of doctors prescribing themselves anything at all. Some were outraged doctors could get early access to a potentially limited stock of medicine. They cited guidance from the American Medical Association (AMA) that doctors-as-patients should normally see their own primary care physicians.

Self-prescribing is legal in most states, as is prescribing for one’s spouse and children, with certain exceptions involving commonly abused drugs. It’s a common practice and, for many drugs, uncontroversial. The AMA reluctantly agrees that self-prescribing may make sense for “short-term, minor problems.” So, doctor, heal thyself—at least thy ear infection.

Scarcity adds a twist here. It now appears there isn’t enough hydroxychloroquine to meet a recent surge in demand. As with toilet paper, the buying phenomenon mirrors the bank run from It’s a Wonderful Life: People fear a resource is running out, decide to stock up before it does, and thereby help deplete the supply. State pharmacy boards quoted in the Times stated some doctors were prescribing absurd quantities for themselves and their families. I hope those cases are few: That’s silly and selfish, and exceeds treatment guidelines, even for a person who is sick. (A normal, experimental course of hydroxychloroquine for COVID-19 ranges from 12 to 30 pills in total.)

What did we choose in our own medical household? I discussed getting a hydroxychloroquine prescription with my wife, who is a retired general surgeon. In the end we decided against it, because others might need it more. I hope we don’t regret that decision, since she is 33 weeks pregnant and I am only relatively low-risk. 

Still, I’m not on the front lines of the coronavirus fight: I practice in a surgery center that currently is taking only the most essential cases. I also have a good face mask. But if I were working in the front lines—especially in a hospital relying on improvised personal protective equipment and expecting me to return from sick leave as quickly as possible—I could well imagine keeping a course of treatment at home.

That doesn’t mean grabbing hundreds of pills. Restricting such massive purchases makes sense. I’m concerned, though, that new restrictions some states are establishing—like an Idaho rule blocking the dispensing of hydroxychloroquine except for prescriptions “consistent with the evidence for its use”—may have unintended side effects. Is it really better for infected doctors and nurses to be without medication that may help them return to service sooner, while their stressed colleagues carry a heavier workload in their absence? And will the new restrictions really affect the bad guys more than the good ones? 

Ultimately, the only real solution to hoarding is spiritual: Six thousand years of human lawmaking haven’t found a way to force the “me-first” out of people. But Jesus’ self-sacrifice shows us the way forward.

I would echo calls to invest funding in drugs that appear promising, so they’re ready to distribute if research supports their use against COVID-19. Closer to home, let’s act with others’ interests in mind: For everyone, it means stay home if you can, avoid unnecessary contact, and wash those hands! For doctors off the front lines, it means conserving protective equipment—and medicines, if possible. 

For those coming into daily contact with the virus? Personally, I’m fine with giving them everything we’ve got. They’re doing the same for us.

Comments

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  • AlanE
    Posted: Sun, 03/29/2020 10:03 am

    We are revealed as sinners in so many ways. The comparison to toilet paper hoarding is apt. When something that upsets our status quo comes on the scene, we respond in ways that reveal our willingness to put self before others--even to the detriment of others.

    One can't help but wonder how much of the currently hoarded food, toilet paper, and now even prescription drugs (or so it appears) will end up in landfills.

  • HB
    Posted: Mon, 03/30/2020 06:21 am

    Well written . Speaking as an old retired doc I see this as a war, frontline med personnel are soldiers on our side! Wouldn't you want your troops to fight with all the armor they can get, including hydroxychloroquine?

    it goes without saying that hoggish hoarding is to be condemned but God bless those haggard defenders who take some hydroxychloroquine after an 18 hour shift and go home to wives and 4 and 14 year old children 

  • MTJanet
    Posted: Wed, 04/01/2020 11:25 am

    Many docs and nurses in our family - young and old.  No one would ask for or acquire the med before its needed as others may need it more.  Thy will be done, Lord, before we ask for our daily bread - or medicine.