Stephanie Desmon has a good story today about the Food and Drug Administration's consideration of a class of "behind the counter" drugs that now require a doctor's prescription but that would be instead be prescribed by a pharmacist after consultation with with patient. Doctors, which would be cut out of the loop, won't like it. But it would free up some of their time now taken up in basic prescriptions such as birth control pills for consultations in which their expertise could be better put to use. It could improve patient access to certain drugs. And it would make better use of pharmacists, whose training is often also underutilized.

Better customer service. Better use of doctors' and pharmacists' intellectual capital. What's not to like? The problem is that even to prescribe birth control pills or weight-loss drugs properly, you have to sit down and spend time privately with the patient. Pharmacies aren't built to do that now. The alternative -- doing a pro-forma "consultation" over the counter and letting patients buy this new class of drugs the way they buy vitamins -- would violate federal privacy laws and risk overdispensation of drugs. If the FDA goes ahead, it must ensure that pharmacists know their patients and that patients are not harmed. Would all that extra work for the pharmacist take too much time, require appointments, increase administrative costs and re-create all the hassles of seeing a doctor, only under a different name? Maybe. That's another reason the FDA should go slowly.

But maybe the biggest reason is this: It's illegal under federal law for pharmacies to own a medical practice. Such a combination would create incentives to prescribe drugs that make more profit for the pharmacy rather than drugs that are best for the patient. That's why Target and Wal-Mart, for their in-store physician clinics, lease space to independent practices rather than employ the docs. If the FDA approves a behind-the-counter system for pharmacy prescriptions, how could it prevent the profit incentive potentially influencing how pharmacists prescribe? I can't think of any.