Switching prescription drugs to over the counter

Editor—Cohen et al suggest that prescription drugs become candidates for switching to being available over the counter if they meet three criteria: use for non-chronic conditions, easy to self diagnose, low potential for misuse.¹ Whether this is the policy of drug regulators is unclear.

Perhaps this view is drawn from examination of current over the counter products? Drugs available over the counter generally meet these criteria; therefore they must be the basis for approving switches. Could this be a chicken and egg scenario?

Most switches are instigated by the manufacturers to generate profits. This requires a potential market for the switched drug, which itself relies on consumers recognising the need for the drug and being motivated to buy it. People less involved in their own health might not see the need for preventive drugs, making switching likely to fail owing to poor sales. So the manufacturers never apply in the first place.

So are the three “chicken” conditions creating a switched “egg,” or does the egg of what would succeed in the marketplace create the chicken conditions?

Today people are better informed about their health and are exposed daily to messages about improving it. The huge growth in stanol margerines, for example, shows that they are open to new interventions to reduce surrogate markers of coronary risk. So is the reason behind over the counter simvastatin a change in consumer behaviours rather than a change in regulatory conditions?

Debate over the evidence has been described elsewhere,² but examination and extrapolation of the existing evidence base shows that there should be benefits, albeit possibly small.