Why aren't rapid strep tests avail OTC?

[PunditLisa]

So I've had a sore throat for a few days. No fever. No rash. I assume I have a virus, but realize that there's a chance it could be strep. Now I could make an appointment with the doctor and have the test taken, but frankly it's a pain in the ass. It costs $25 to walk in the door and more often than not, after a strep test, I'm told "It's probably allergies" and sent along my way. So I'm reticent to call, esp since I have no other symptoms.

Which begs the question: Why aren't rapid tests avail OTC? After all, diabetics are entrusted to monitor their own blood sugar and dose themselves with the appropriate amount of insulin so they don't die. Why in the world don't doctors entrust me to swab the back of my throat, or my kids' throats, so that I know whether I need an antibiotic? If it came back positive, I could call the doctor and make an appt so that she can write me a scrip. Or better yet, I could produce a positive test to the pharmacist and have the doctor's office PHONE in a prescription.

[Shagnasty]

Because there is a whole lot more to medicine that simply doing rapid tests and then reading a color code on the back of the box. There is presumably something seriously wrong so the patient would need to see the doctor anyway and the doctor can evaluate the health of the whole patient, not just test for one possible thing. Plus, the test could be inaccurate and the doctors clinical knowledge could catch the mistake. Maybe it is something even worse.

Strep can be serious. If it is there, the doctor needs to know about it to tell the patient what to do and possible coerce them into treatment. Doctors are authority figures and this effect is often beneficial to patients. OTC tests don't have that authority.

Diabetic get to do some of their won procedures A) because they have to do it often and it wouldn't be practical to have to go to a clinic all the time B) They do it so often that they get good at it and become experts on their body and the disease themselves.

One off home lab tests don't have those traits.

[PunditLisa]

Originally Posted by Shagnasty

Because there is a whole lot more to medicine that simply doing rapid tests and then reading a color code on the back of the box.

I agree. However, there is not a whole lot more to doing a rapid strep test than swabbing your tonsils and applying it to a strip. Once again, there are some things I am admittedly qualified to perform and others that I am not. If I'm willing and able to do it, then I should be empowered to do it.

Originally Posted by Shagnasty

Strep can be serious. If it is there, the doctor needs to know about it to tell the patient what to do and possible coerce them into treatment. Doctors are authority figures and this effect is often beneficial to patients. OTC tests don't have that authority.

Yes, strep is serious. Why is it that some people end up with scarlet fever/rheumatic fever in a day and age where a simple diagnostic tool and antiobiotics to treat it are widely available? My theory is that more people end up with repercussions because it's a pain in the ass to go to the doctor every time you have a sore throat.

To me, it's no different than having complimentary blood pressure machines. If you KNOW you have high blood pressure, you are much more willing to SEEK medical attention. To me, a sore throat is a judgment call: should I go and see the doctor or wait it out? But a positive Strep A test is NOT a judgment call. I NEED to see the doctor. So why not allow me to take more control of my health and do the simple diagnostic test on my own?

[Shagnasty]

I think the biggest problem it isn't strep but something else that is serious. People will take the negative strep test to mean that they are in the clear for the serious things when they may not be.

A OTC test presumes that people are qualified to narrow down their condition on their own, seek out a test for that condition, and then decide what to do based on the results. Those actions are firmly in the realm of professional medicine.

Other problems include borderline results as well as false negatives that aren't caught by professional judgement.

Available OTC tests don't make those same assumptions. The conditions are fundamentally different and don't involve the complexities of microbiology.

[Smeghead]

Also, swabbing someone's throat does require a certain amount of technique. You can't really train the general public in sterile sample handling requirements on the back of a box. At least not reliably.

[cowboy0812]

I so Agree with your complaint about an OTC strep test not being available for two reasons:

1. The reasons other site as a reason for not allowing them is, "that people wont get themselves a complete exam which could catch other illness" so how would people waiting longer to get examined helped this? By human nature, the more inconvenient it is to get an examination the longer a person will wait and most, especially the poor with out insurance will not go at all. CVS charges 89.00 plus 27.00 for the test, I can tell you I don't have 116.00 plus tax to basically swab my throat. You seem to forget the cost factor is always weighted, even for those not poor.

2. The second larger society wide issue is that antibiotics are prescribed at an alarming rate by these very same doctors you claim to be the experts in the field. Why is this? They can't deal with nor want to deal with saying no confidently and the result is that people get sent on their way with an antibiotic for a disease (a bacterial one) that doesn't exist. I have lived in PA, FL, CT, NJ, CA, MN x 2, have in each place very quickly found a doc that will simply do what I want. He will call in whatever script I need and not even see me. If I can find this in all of these new states, what do you think the chances are that a person will find this if they grew up and live in the same state for their entire life. There is also cheap online antibiotics and if I did not have the money for an exam and test, I just might play it safe and selfishly take one (in case) .

The result, super-bugs (antibiotic resistant bacteria) are developing and these tests would lessen the demand for an antibiotic that is not needed.

One final point is that this all comes down to money. Doctors want to be seen now and paid now simply to write prescriptions. Thank god I live in one of the few states with medical insurance (MN), as I do not have it through an employers. I would have to pay 375.00 a month plus the cost of the prescriptions every month for him to write me an ADHD and a antidepressant medication I have been on for over 10 years. Why, I know I need it every month, he does not examine or interview me, he doesn't look for other conditions, he just writes a script. CVS or other docs charging 80-100 bucks for a cash appointment plus testing is part of the scheme of the medical system that is about syphoning every last dollar they can from the public!

That's the bottom!

Originally Posted by PunditLisa

So I've had a sore throat for a few days. No fever. No rash. I assume I have a virus, but realize that there's a chance it could be strep. Now I could make an appointment with the doctor and have the test taken, but frankly it's a pain in the ass. It costs $25 to walk in the door and more often than not, after a strep test, I'm told "It's probably allergies" and sent along my way. So I'm reticent to call, esp since I have no other symptoms.

Which begs the question: Why aren't rapid tests avail OTC? After all, diabetics are entrusted to monitor their own blood sugar and dose themselves with the appropriate amount of insulin so they don't die. Why in the world don't doctors entrust me to swab the back of my throat, or my kids' throats, so that I know whether I need an antibiotic? If it came back positive, I could call the doctor and make an appt so that she can write me a scrip. Or better yet, I could produce a positive test to the pharmacist and have the doctor's office PHONE in a prescription.

[Nametag]

http://www.amazon.com/Rapid-Response.../dp/B001DD04SQ

However, they don't trust you to swab the back of the throat because it's hard to swab the throat and the tonsils without touching the tongue or the uvula.

[Leaper]

So, PunditLisa, was it strep? Or do you not remember anymore?

[BigT]

My guess: you have to go to the doctor anyway to get the antibiotic. The idea is that, if you don't know it's strep, you'll be more likely to go to the doctor, which can cover other bacterial infections. They don't want you figuring out it isn't strep but then not going in and getting the antibiotics you need.

Though now that they are doing their best to not give out antibiotics unless absolutely necessary, I'm not sure that logic would hold up. But doctors are oddly conservative for a group of people who are constantly discovering new treatments.

[DSeid]

Old thread but still ...

As noted, getting a good swab is not something most can do on themselves or on their kids. My own WAG is that a large number of false negatives are a result of poor swab technique even in the hands of professionals who do many of them. And only a few of the Rapid Strep products have good enough sensitivity to believe a negative in the context of a story and exam more consistent with strep than viral sore throat (and if the story and exam are much more consistent with a viral sore throat it is wiser to not swab at all; false positives happen too). Without knowing the test is one of those products a negative in a clinically suspicious circumstance should be backed up with a culture.

Yes, sometimes a sore throat is more than strep. A few times a year someone comes in for sore throat and actually has what is called a peritonsillar abcess. Sometimes those can be treated, if diagnosed early enough, with a stronger/different by mouth antibiotic but often they need to get to an Ear/Nose/Throat surgeon and have it drained.

Another concern is that some patients want antibiotics for a variety of not so very good clinical reasons. Trusting a phone call of a test the doctor did not do, even if something purported to be the patients test strip was handed to a pharmacist, would be an opportunity for some to get medicine inappropriately.

[EverwonderWhy]

Originally Posted by PunditLisa

So I've had a sore throat for a few days. No fever. No rash. I assume I have a virus, but realize that there's a chance it could be strep. Now I could make an appointment with the doctor and have the test taken, but frankly it's a pain in the ass. It costs $25 to walk in the door and more often than not, after a strep test, I'm told "It's probably allergies" and sent along my way. So I'm reticent to call, esp since I have no other symptoms.

Which begs the question: Why aren't rapid tests avail OTC? After all, diabetics are entrusted to monitor their own blood sugar and dose themselves with the appropriate amount of insulin so they don't die. Why in the world don't doctors entrust me to swab the back of my throat, or my kids' throats, so that I know whether I need an antibiotic? If it came back positive, I could call the doctor and make an appt so that she can write me a scrip. Or better yet, I could produce a positive test to the pharmacist and have the doctor's office PHONE in a prescription.

Hah, I have thought this about UTI's! Just give me a pee test I can take to the pharmacist for a perscription.

[septimus]

I've told the following anecdote before but may as well tack it on to this zombie thread....

I've had quite a few sore throats over the decades and am always able to tell whether it is strep or not -- the pain sensation (at least for me) of strep is quite distinctive. I didn't take a strep test for each and every sore throat, but when I did there was perfect correlation between the peculiar pain sensation and the strep diagnosis. The pain is high but by "peculiar" I mean more than that; I can't explain the distinctive pain in words but, although I last had strep in the 1990's, I assume I'd recognize it if I got it again.

The time in the 1990's when I had strep, I knew I had it. (Not only did I have the peculiar pain, but I'd just moved into a house whose residents had only just gotten over it. ) It was in the U.S., so of course the only possible first step was to consult a physician for a strep culture. He took one look at my tonsils and said "Bright red. I can save you the $25 test; you have strep." (Thanks. I already knew it; wish I could have saved the $45 for you to spend 30 seconds looking at my tonsils.)

I don't know the moral of the story, but it does seem interesting that at least some patients have information (e.g. details of pain sensation) which cannot be easily communicated, at least believably, to physician. As another example, during my brief playboy-like fling in the early 1980's I frequently got gonorrhea or NSU -- I'd eventually know which since I always submitted to the test -- and soon reached a point where I predicted, from the pain sensation, with 100% success whether it was gonorrhea or NSU! (Yes, I did change modus operandi when AIDS appeared on the scene.)