Americans visit their physicians one billion times a year. One of the primary reasons patients see their doctors is to obtain or renew a prescription. Nearly three-quarters of physician visits (71.9%) result in drug therapy.
Drugs are the most convenient and efficient method to treat most illnesses. About half of Americans took a prescription drug in the past month. One-quarter took three or more prescription drugs in the past 30 days. One reason drug therapy is both convenient and efficient is because drugs reduce the need for inpatient care, allowing patients to care for themselves in the comfort of their own home. Over the counter (OTC) drugs are even more efficient and convenient because patients can procure them without a doctor’s prescription. The Consumer Healthcare Products Association reports that every $1 dollar spent on OTC medications saves $7.33, partly because there is no need for a physician visit to obtain the drug.
It is not always easy to get in to see your doctor. The average waiting time for an office visit is about 30 days. All manner of online telemedicine firms have sprung up since Covid to make it easier to obtain a prescription drug. Want Viagra? Just fill out a form online and for a fee generic pills will arrive by mail. Want to lose weight? There are plenty of telemedicine firms willing to send vials of GLP-1 drugs with syringes on a monthly subscription. These services take advantage of regulations that made physicians the gatekeepers to prescription medications.
An editorial in the Washington Post discusses a new prescription renewal service currently only available in Utah:
In Utah, an artificial intelligence platform called Doctronic is legally renewing prescription medications for patients without physician involvement. For a $4 fee, it conducts the intake, evaluates the patient and sends the prescription to a pharmacy.
Operating under a state regulatory exemption, this is a live commercial program handling real prescriptions for real patients with plans to expand to a dozen more states this year.
The authors of the opinion editorial advise against the new service, arguing it is based on one unvalidated study, saying:
That study is a preprint posted to the online site medRxiv in July. It has not been peer-reviewed. All eight of its authors hold equity in Doctronic. The company’s own internal committee conducted the ethics review. Colleagues requesting the underlying data were denied it. Eight months later, the study still hasn’t been published in a peer-reviewed journal.
That is the evidentiary foundation for the first autonomous AI prescribing program in the United States. And it is cause for serious concern.
I for one am not concerned about AI prescribing. I am concerned it has not yet reached Texas.
The company’s cornerstone claim is that its AI matches human clinician treatment plans 99.2 percent of the time. State regulators have cited this figure. News outlets have repeated it. It has become the number that justifies the whole operation.
The two authors – a physician and a medical student – fear such AI-ordered refills could result in a public health crisis. They say that even if the 99.2% accurate treatment rate is correct that could still result in thousands of patients potentially harmed if the experiment is scaled up. Something the authors apparently did not consider is the potential harm from access barriers to medications when patients cannot afford a physician visit or give up due to the hassle. The regulatory mechanism for obtaining prescription drugs both drives up the cost and reduces access to convenient drug therapy. While there are some risks with AI prescription renewal, there are also some opportunities to assess new ways to improve drug adherence.
Why do patients have to trek to their doctors before obtaining a prescription drug? Most Americans probably assume it has always been this way. Yet that is not true. The Durham-Humphrey Amendment of 1951 established a clear distinction between prescription and over-the-counter medications, creating two distinct classes of drugs. Consumers can buy OTC drugs off the shelf, whereas a physicians must prescribe a prescription drug. Anything that can lessen the gatekeeper to drug therapy will boost access to care.
Read more at WaPo: Opinion | AI is prescribing meds based on little evidence that it’s accurate