Sell Statins OTC? The Pros and Cons

The recent editorial by David T. Nash, MD, "OTC Statins: Panacea or Pandora's Box?" (CONSULTANT, July 2006, page 845), prompted a number of readers to write in. A selection of the comments received, along with a response from Dr Nash, appears below. Additional comments appear on www.ConsultantLive.com.

- The Editors

I feel very strongly that the cons outweigh the pros with respect to OTC statins and that OTC sales of these agents would lead to very suboptimal cholesterol treatment in the vast majority of patients.

- Robert P. Blereau, MD
   Morgan City, La

My first reaction is to allow statins to be sold OTC because that would make them more affordable, especially to older persons living on a fixed income. Probably many drugs that are now available OTC are more harmful than the statins.

- Gene M. Gaertner, MD
   Freeport, Ill

I am an American who was working in the United Kingdom at the time simvastatin became available OTC there. At first, I was a bit skeptical about the safety and efficacy of this policy. However, while I was there, I learned why the United Kingdom's health outcomes surpass those in this country despite the billions of dollars we spend here.

In the United Kingdom, pharmacies and pharmacists are seen as part of the health care team. Targets and goals for various disease processes are set by the department of health, and primary care groups are rewarded for meeting these goals. Blood pressure and cholesterol levels are just 2 of the areas in which such targets have been established. To meet these goals, all members of the health care team are involved.

Pharmacies in the United Kingdom operate somewhat differently than they do in the United States. Medications such as analgesics and cough preparations are kept "behind the counter," and one must seek the advice of the pharmacist to access them. This consultation is even more important in the case of a previously prescription-only medication such as simvastatin. Pharmacists have strict guidelines for dispensation and follow-up to ensure safety. Still, obtaining these needed medications is much easier than it was when one had to visit a general practitioner and obtain a prescription, which might literally take weeks. This liberal and more team-based approach leads to better health outcomes than does the willy-nilly care that is seen here more often than we'd like to admit.

- Marsha Jaroch, NP
   Lone Tree, Colo

I am against most medications being sold OTC, but especially the statins. Most patients think that if a little of something is good, more is better. Or they will stop taking the agent because they think they feel well. They won't remember the name of the OTC drug, so their health care provider won't know whether a prescribed drug will interact with it. In addition, patients may not make the connection between adverse effects and the OTC agent they are taking. Finally, it will not be possible to call the pharmacy and get a list of the patient's medications if these drugs are sold OTC.

I don't mean to sound cynical, but making statins available OTC implies a confidence in people that I don't share.

- Laura Zagon, PA-C
   Charlotte, NC

Dr Nash's response to these comments follows:

The editorial has elicited a spirited response--just the kind of public debate that is needed on this issue. I believe that the question of whether to make statins available OTC in the United States will continue to evolve in the foreseeable future. In an earlier generation, physicians made most therapeutic decisions and most patients complied, but the future of medical care--for better or worse--is going to be different. Patients now expect to play an active role in their health care, and in fact, they have much more control over their medical care than they once did. Much of this new involvement is powered by the Internet, where patients can now access all sorts of health information. Some become more knowledgeable; however, others are misled by pseudoscience or advertisements that offer wishful thinking disguised as "objective" information.

Medicine is changing and we must adapt. Perhaps we can look to such ancient principles as "moderation in all things" and caveat emptor ("let the buyer beware") for guidance as we enter the brave new world of 21st century health care.

- David T. Nash, MD
   Clinical Professor of Medicine
   State University of New York
   Upstate Medical University
   Syracuse