Monday, May 07, 2007

Drugs and Informed Consent

There's an article on the Denialism blog discussing whether or not drugs should be approved and regulated by the FDA or whether they should be unregulated to let informed consumers make their own decisions. One of the points of argument is whether or not the average person can be expected to really know enough about drugs to be truly informed. If not, some argue, then there is need for the FDA approval process to weed out harmful drugs.

Here's my take: Uninformed consumers of drugs are screwed, with or without the FDA.

Doctors make mistakes all the time. They have biases and blind spots like everyone else. They are also susceptible to the same marketing as consumers.

I've been to at least three doctors who completely botched diagnoses and prescribed inappropriate drugs. I have had doctors who were set on using a particular medication to the point that I had to change doctors to get a new medication, even after informing the doctor of the debilitating side-effects of the drug. I can't imagine what would have happened to me if I hadn't done the work and research to know when those doctors were wrong and when not to take the medications they prescribed.

Personally, I don't go to the doctor without being fairly certain of what is wrong with me. If the doctor has a different theory, I explain my theory to him or her and expect the doctor to defend his or her theory (if he or she doesn't accept mine). So far, I have always been right.

But the fact is that most people are not inclined to put in the work necessary to become informed consumers of drugs. And many people, in my opinion, wouldn't be able to make informed choices even with research. Many people just don't have sufficient critical thinking skills to make such decisions. That's a fact. I'm not sure I would encourage those people to take matters into their own hands: I personally know a lot of people who would probably end up killing themselves if they did. Those people have no choice but to rely on the expertise of doctors and agencies like the FDA.

But they're still screwed. A little less screwed with the FDA than without? I'd say so. I don't think the invisible hand of the market works well in areas where consumers are not well informed and so the idea of letting consumers decide which drugs should be on the market is likely a disastrous idea. It was pretty disastrous when we tried it before, and that's why we have the FDA.

But still, the issue of FDA drug approval or not is pretty insignificant next to the problem that most people don't know crap about what the hell is in all the colorful little pills they're taking.


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