... is always top-down, particularly in that city of the exalted, Washington D.C. So what is it this time? "A Food and Drug Administration medical reviewer said it wasn't clear if consumers could safely and effectively use a proposed Merck & Co. cholesterol-lowering drug without a prescription." (Wall Street Journal, December 11)
And that just about sums it all up, doesn't it? Forget consultations between doctors and their patients. Forget the heterogeneous characteristics and needs of millions of individual patients. Forget the huge informational advantage engendered by ongoing experience, modern mass communication, and individual trial and error. Forget the reality that some very substantial proportion of prescriptions are for off-label uses. Sorry: The Beltway knows best, children---because it says so---and "safety and effectiveness" is one-size-fits-all.
It is not only inside the Beltway that this sort of arrogance is to be found, but it is the Beltway in which it is rewarded so consistently and in which it simply is more than a way of life. It is a mindset.
[cross-posted from www.medicalprogresstoday.com/blog/]