Prescription-Only Requirements

Prior to 1938, a consumer could buy any nonnarcotic drug without first obtaining a doctor’s prescription. Consumers often obtained prescriptions or at least sought the advice of physicians before self-medicating, but were under no legal compulsion to do so. The situation may seem remarkable, but why? Today car owners may use the services of a certified auto mechanic to fix their cars but are not required to obtain a mechanic’s prescription before working on the car (despite the fact that improper maintenance can be dangerous). As noted in the text, the creation of the prescription-only class of drugs was a regulatory decision made by the FDA and seemingly at odds with congressional intent.

If there were no prescription requirements today, many consumers would continue to seek a doctor’s advice or prescription for some conditions, just as they did prior to 1938. The main effect of a prescription requirement is to make it more difficult to obtain the drugs that consumers would otherwise obtain without a prescription. Consumers do not have the scientific knowledge that doctors have, but they do have the best knowledge of their own personal situation, history, and costs of going to see the doctor. Moreover, they are the ones who taste the consequences of properly or improperly treating their sickness. So, in a world without prescription requirements, they would still have motivation to improve their practical knowledge of whether it is necessary to see a doctor and get a prescription (Peltzman 1987). Drugs they would buy without a prescription, if permitted, would tend to be drugs for which the doctor’s advice is not particularly necessary. But prescription requirement often prevent consumers from obtain simple remedies. By raising the costs of obtaining drugs, prescription requirements raise the cost of health care and thereby reduce treatment and injure health.

Some will contend that prescription-only requirements protect consumers from their own ignorance and haste. Peltzman (1987) compares accidental poisonings in the United States before and after the 1938 law and across countries today. He concludes that "enforcement of prescription-only regulation does not significantly improve the health of drug consumers. . . . Apparently, consumers are able to understand the value of a doctor’s advice even if they are not required to seek it" (235–36).

One legitimate concern with relaxing prescription-only requirements is the possibility of excerbating already serious problems with antibiotic resistance. When antibiotics are used indiscriminately for nonbacterial infections or when they are not taken in a full course, bacteria can become resistant, and such resistance can rapidly spread throughout an entire population. Prescription-only requirements for antibiotics might, therefore, be a wise measure on the grounds that improper use can cause external effects (i.e., can negatively affect other people.) Unfortunately, prescription-only requirements have not kept the problem of antibiotic resistance under control.

Temin (1992) examines the costs and benefits of switching from a prescription-only status to an over-the-counter status for drugs and finds that the benefits have been large. Peltzman’s and Temin’s results suggest that, with the exception perhaps of antibiotics, prescription requirements should be abandoned or at least loosened.