Practicing "medicine" without a license. . .

As the medical system in America increasingly moves to the screen and a visit to your physician may include a URL, we have not quite faced the full consequences of the direction we are headed.  Furthermore, as physician assistants and nurse practioners become the ordinary physicians and regular MDs more their supervisors, we will have to discuss the consequences not simply for the patient but for medicine itself.  As urgent care centers become the de facto primary care providers for more and more people, we will have to consider how that will change things down the road.  All of these are honest and legitimate questions.  One that should not be honest or legitimate or legal is deferring to the pharmacist to prescribe treatment for patients.  Yet that is effectively what is happening.  Washington the state (not the District of Columbia) set up a program for select pharmacists to do just that with the drugs used to cause an abortion -- the so-called morning after pill.  Mifepristone is not quite the same as a flu vaccine or even birth control and these are already prescribed by pharmacists in some states.  The outcome of this "medicine" is a death.

Some states have decided that free access to drugs which are designed to kill the child in the womb is more important than honoring the medical history of patient evaluation by a licensed physician who can and should consider the whole of the patient in addressing particular issues.  Abortion is so important to some Americans and in some states that it must be available at a single visit to a pharmacy.  Though I have great respect for pharmacists -- indeed, some of the smartest people I know -- that is not what they were educated to do or licensed to do.  Treating patients is something different.  No matter how states might tweak the language, deferring to a pharmacist to prescribe treatment, especially one designed to cause a death, is practicing medicine without a license.  If you call abortion medicine!  The pharmacist can certainly distribute the drugs and probably knows more about what he would distribute than the physician but he is not situated to provide follow up care, to evaluate medical history, to monitor for complications, and to issue lab orders -- much less pick up the pieces when it all goes wrong!  So will we be setting up exam rooms, issuing lab orders, taking patient histories, and intervening when things go south -- all the while people are waiting for someone to dispense the thyroid medicine or antibiotic which must be prescribed by a real physician?  I guess we began this when pill factories began to set up consults over the phone so that the little blue pills could be distributed.  Certain things are so important to Americans that they can and do bypass all the other protocols put in place in reasoned and legitimate health care.

For those of you who wonder what rattled my cage today, let me remind you.  More than 60% of all abortions in America today do not happen at a Planned Parenthood facility or in a hospital but through an abortion pill.  They get it at a pharmacy (at least until we decide to prescribe them through vending machines) and take it at home.  Does it ever go bad?  Is anything foolproof?  The complication rate is low (5% or less) but that number does not take into account that the older the patient who takes the drugs the more likely there are complications with this easy, private, do-it-yourself method of abortion.  Though marketed as safe and effective, the abortion pill can actually be quite dangerous — four times more dangerous for women than surgical abortions.  When we talk about abortion, we are first of all talking about the chemical abortions that may start with a visit to your pharmacist.  I have nothing against the pharmacist -- as I said, some of the brightest people I know are pharmacists -- but I do have something against a society which is so intent upon making the right to kill the child in the womb free, easy, and accessible that it may not be thinking of what is in the best interest of the woman.  We already know that the child in the womb has neither voice nor vote in the matter.