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drugs double the rate of major birth defects and miscarriages. Drug companies like GlaxoSmithKline are aware that farmers have known for centuries to keep their herds out of fields in which the serotonin-reuptake-inhibiting St. John's wort grows as it leads to miscarriages, but these same drug companies have still manipulated doctors very successfully into herding women into the pastures in which their serotonin reuptake inhibitors grow. 9
    There are other benefits that might flow from lifting the prescriptiononly status of many drugs. The current arrangements constrain new drugs within a disease framework. If this were changed, a range of diseases from social phobia to osteopenia would vanish overnight. In the case of the antidepressants, for example, some that enhance appetite and sleep might be marketed as tonics rather than for depression. The SSRIs are more like St. John's wort and might be marketed similarly—for stress or burnout. At present, to get Prozac a person has to be labeled as suffering from depression or social phobia or obsessivecompulsive disorder first. If the drugs were marketed instead for stress or burnout there would be much less stigma in using them. In the case of the statins for cholesterol or biphosphonates for osteoporosis, the marketing would likely be aimed more for keeping arteries or bones young and not for supposed diseases. There might have been no fewer drugs sold but we would have fewer diseases. There would be a greater dividing line between medicine and daily life than there is now.
    If many more drugs were available over the counter, company marketing would doubtless throw up a different set of abuses. It is doubtful, though, if the abuses could be any worse than the marketing of the proprietary panaceas that dominated the drug market in the late nineteenth and early twentieth centuries. But a century ago, when faced with these panaceas, there was a group of skeptics we could turn to— doctors. There are no skeptics now, and there need to be.
    Where in the 1960s there was a gulf between the pharmaceutical and tobacco industries, partly owing to prescription-only arrangements, now it is increasingly difficult to distinguish between the two, except insofar as medicine supports one and not the other. If our current blockbusters were available over the counter, there is little doubt that the pharmaceutical industry would have marketed them as vigorously as the tobacco industry marketed cigarettes and likely caused as much damage with them as tobacco has. Would we be safer if our current blockbusters came with warnings that have the clarity of those found on tobacco products?
    Abolishing prescription-only arrangements is a thought experiment. We have a tendency however to solve problems by opting for more rather than less regulation, and it is unlikely that this thought experiment is ever likely to be adopted. What we perhaps need to appreciate however is that these regulations are part of a growing apparatus within healthcare that Sam Sessions has referred to as a “Shadow Government.” 10 Doctors are no longer free to follow the market for drugs on the basis of price or quality—they have to adhere to a variety of diktats in the form of guidelines and other instruments that have been fostered by companies. It is this range of instruments that pivot on the existence of prescription-only arrangements that effectively govern healthcare today. Whether in the United States or Europe, voices are increasingly raised against the involvement of government in healthcare—but when we look to Washington or other capitals for the culprits we are looking to the wrong place.
    Another thought experiment might bring out what else could be done to make a prescription-only market work more efficiently than it does now.
    RXISK.COM
    In August 1973, a bank robbery at the Kreditbanken in Stockholm triggered a five-day siege with bank employees held hostage. After the siege ended, to the