Prescription for savings.

As the Food and Drug Administration loosens its hold on prescription drugs, Americans increasingly are medicating themselves with products they buy over the counter. A recent study by the consulting firm Kline & Company finds they're saving some $10 billion a year by avoiding extra insurance costs, doctor's appointments, and time lost from work.

Hydrocortisone, used to treat minor skin irritations, and antihistamines such as chlorpheniramine are just a few of the more than 400 drugs switched from prescription to over-the-counter status in recent years. Drug companies are expected to ask the FDA to switch an additional 70 or so drugs, including the popular sinus medication Seldane and a number of ulcer drugs, within the next few years.

In a 1983 paper in the Journal of Health Economics, MIT economist Peter Temin estimated that the economic benefits of making hydrocortisone available over the counter "exceeded the costs by over $200 million in 1980 and $400 million in 1981."

The switch also relieved discomfort that might otherwise have gone untreated: The first year hydrocortisone was available over the counter, non-prescription sales were about double the prescription sales, which remained about the same as the previous year's. Temin concluded that "the switch apparently allowed a new class of consumers to use hydrocortisone."

Because prescription drugs are closely monitored by drug companies and health professionals, their effectiveness and safety are well documented before they are switched to over-the-counter status. Nonetheless, groups such as the American Pharmaceutical Association still worry about consumers medicating themselves without supervision. They have proposed a third class of drugs between prescription and over-the-counter, similar to categories in countries such as Canada, France, Germany, and Switzerland.

Drugs in this third class would not require a prescription but would be available only from a pharmacist, who would offer guidance about drug interactions and side effects. If no unforeseen side effects were reported by pharmacists after several years, the drug would be made available over the counter.

The FDA and the Nonprescription Drug Manufacturers Association oppose the idea of a three-class system. The NDMA's senior vice president, Jack Walden, told the Tucson Citizen that a third class of drugs would be "anti-consumer, anti-competitive, anti-convenience."

Although this proposal would not give customers complete autonomy, it might give them more freedom than the current system by increasing access to drugs that would otherwise have been available only through a doctor. And, if drugs in the third class are eventually moved to over-the-counter status as planned, customers may still consult with pharmacists. People act responsibly when it comes to self-medication, notes The Economist, because "after all, the bodies they are treating are their own."