Lanthanide

This is fascinating, and a niche where I can definitely see a smaller player causing a splash and driving down prices for nuclear medicine.

My question is, how equipped are you to handle regulatory hurdles for international customers? It's one thing for a small firm to deal with US civil nuclear regulations, but how are you going to deal with the regulators of each foreign market you intend to export to? I imagine that this is something that the larger providers in the field use economies of scale to deal with, but could be a hurdle for a startup.

Both. Anecdotally I’d actually say that the ratio of MTF surgeries to FTM ones is higher than usual over here.

Not in the US style of drug ads, but not completely banned either; things like Tylenol and the various cold and flu drugs can be advertised. I’ve never seen ads for something that would be prescription-only in other countries except for Viagra and a coupe of other ED drugs, and that’s an edge case.

As far as I can see all drug advertisements (including things such as social media promotions) have to be approved by the Saudi FDA, and they don’t seem lenient at all in allowing ads for anything beyond the aforementioned meds.

Aisle 5, right next to the condoms and lube bottles =) and Victoria Secret makes money hand over fist here.

This would be off-topic here, but I think most people outside of the region would be stunned about the state of sex-change operations over here. They happen VERY frequently, albeit with a heavy veil of privacy.

I actually agree with most of your points. I don't think this is ideal at all, I just think it's a less-harmful solution (and hopefully a temporary one) in the face of systemic dysfunction in healthcare. The alternative seems to skew less towards "oh I guess now I should see a doctor about that condition now" when facing pharmaceutical hurdles and more towards the "I guess I will tough it out; I can't handle the wait times for public hospitals or the costs of private ones". The lack development in centralized patient records entrenches this problem.

The self-medication thing is a seriously double-edged sword. You elucidated why very clearly. I have two reasons though to believe that it's a SLIGHTLY less risky practice over here;

1, pharmacists are very engaged with patients in recommending medications and constantly steer them to doctors- and they are more confidant with in-class substitutions rather than dispensing to a patient outright without vitals or history (beyond what is disclosed orally by the patient). However, they'll still recommend medications freely when they judge them as being unlikely to go to a doctor otherwise, hence risking more damage. Lesser evil and all that.

2, a long history of OTC availability of medications, where controlled prescriptions are the exception rather than the norm, seems to have lead to a culture of caution and careful reading of medication leaflets, asking the pharmacists, etc. I don't mean this as necessarily a good thing, I think this is more of a "you're on your own" mentality with regards to being careful with medications. This mentality grew, I think, partially from issues with access to doctors (governmental neighborhood health centers, kind of like small GP practices in the US/UK, are a somewhat new thing here. It was all centered around huge hospitals in the past). The bigger problem, in my opinion, is that this mode of thinking is about to be reinforced further by rising healthcare costs in the face of the rapid privatization of the healthcare sector, and it will clash with increasing OTC regulations.

One aside I will say about antidepressives which you mention; I think this merits a special examination separate from the rest of the healthcare issues. I've slowly come to realize that a massive portion of the population here are actually on antidepressants (mostly SSRI and SNRI meds). Why is this notable? Because it's not anywhere near commensurate with the number of people using psychotherapy or visiting psychiatrists. The reason, I believe, is because there is such a stigma around mental illness here that I think it would be very difficult to get many of these patients into more suitable therapy, and OTC Prozac or what have you helps hide the ""shame"". We're finally, FINALLY slowly moving past this stigma, probably catching up with the public attitude of the US/EU towards mental health in the 1980s or so. I really hope this will eventually lead to mental health patients not feeling that they need to self-medicate.

Edit: I forgot to mention that you're also completely correct in the assumption about quack medicine. It is, unfortunately, endemic here. It's a constant struggle to convince loved ones that, no, Supplement X is neither a peer-reviewed medication nor is it an alternative for treatment. At the very least the regulatory environment is increasingly more strict about misleading medical claims on herbal products, etc

The subsidy/export explanation does make a lot more sense, since it's not exactly in a high-risk drug class. I suppose those regulations could have been misinterpreted by him to mean he needed a prescription.

(unless Austria, where this happened, really does have very strict OTC drug laws on medical grounds)

I live in a country where this scheme is already the norm (Saudi Arabia) and I can say that while it's not necessarily ideal, I much prefer it to the alternative. It plugs some seriously annoying holes in the healthcare experience and frees up doctors' time for more patients.

As it is, the only medications that require a prescription to buy in Saudi are psychotropic ones, narcotics, and most recently, antibiotics. Things like insulin, birth control medications, hypertension medications, even antidepressants and anti-psychotics- they are all OTC. And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor.

The reason that this is the norm here is twofold; one, health insurance wasn't much of a thing here until a few years ago. The second reason (and the reason health insurance didn't factor in until recently) is that the socialized healthcare system here was (and still is) stretched thin; seeing a doctor to get prescriptions for every little thing becomes prohibitively difficult, with appointments taking months.

It's asinine to expect someone suffering from, say, an acute athsma attack to try to navigate ERs or try to see a doctor on short notice during a crisis, when a pharmacist would be able to dispense the exact medication needed, leaving the others free for more complex cases that need closer attention.

Edit: this actually created a bit of culture shock for an older friend of mine. He was traveling to an EU country for the first time and didn't do his homework- he thought he he could simply walk into any pharmacy and ask for a pack of his cholesterol medication, as he usually does back home. I don't envy the poor pharmacist that had to keep trying to explain the dispensing system to him and to emphasize that yes, they are aware that it's Lipitor, not morphine, it's just how the regulation is.

Things get a bit more difficult when the identity is standing in the way of creating wealth. This seems to be the case here, assuming EU/NATO memberships would be largely positive economic forces for Macedonia.

I'm tempted to apologize on behalf of my countrymen, but hell no- those reprobates are a national embarrassment to us all over Europe, and deserve the antipathy. I'm sorry you have to suffer through their douchiness, however.

I audibly groan whenever I see GCC license plate on the road in London; these fuckers are part of the reason why I have to either lie about my nationality when asked, or to slowly explain that most of us drive Hyundais back home, not Bentleys.

Edit: regarding the diplomatic immunity, it's not as much of a carte blanche as most assume it is. The bills aren't waived by any means just due to the immunity- they just go to the embassy instead. The embassy usually pays up then chases them down back home to get reimbursed, though often unsuccessfully I'm afraid.

Thanks for the headsup, love Ben's stuff but I haven't caught up with it in a long time, I'll be sure to check it out.

Hah, while that would be hilarious it's not what it means in context; it refers to the apps block being lifted at midnight this past Wednesday.