In Germany the story is slightly different since about 20% of herbal medicine is sold only on a prescription-basis and about 80% is sold over the counter. Regardless of how they are obtained the rate of herbal medicine use is on the increase. Between 1970 and 2010 the overall number of Germans using herbal medicine increased to well over two-thirds of the population. All expenditure on herbal remedies amounts to approximately one billion euros. Given there are other retail outlets such as drugstores and the internet, the usage is probably considerably higher. The propensity to pop pills seems endless in many countries, so why has this trend occurred?
There are several reasons for self-medicating. Since we are no longer the passive consumers of health we once were, many of us want to take charge of our own health and what happens to our body. Self-diagnosing and medicating engenders a feeling of control. But how many of us take the time to thoroughly investigate whether the OTC remedies actually relieve symptoms and/or promote health? The answer is probably very few. Yet it is an indisputable fact that consumers in the USA, UK, Europe and Australia do not take herbal remedies and vitamins simply as dietary supplements, although this is how they are officially classified. Nearly a quarter of Australian adults use complementary and alternative medicine in the treatment of chronic illness according to a National Health Survey database. In this group the complementary medicines were used for arthritis and osteoporosis but fewer than 10 per cent used non-prescription medicines for asthma, diabetes or heart and circulatory conditions. As might be expected these users tended to be older females with lower education levels and income,[v] and that is unlike Australian OTC users in general, who tend to have higher education and incomes levels as noted below.
Quite obviously many people expect OTC medicines to have a therapeutic effect. When taking echinacea for colds or flu it is expected to have some effect on the body, just as a prescription for an antibiotic for pneumonia is expected to work. When an analgesic such as Panadol is taken for arthritis pain, relief is the expected outcome and the same applies for non-steroidal anti-inflammatory drugs (NSAIDs). In terms of effectiveness the reason for taking these OTC remedies is much the same as the reason for taking prescription drugs and they are used in similar ways.
Another reason why self-medication is so widely used is that remedies for mild complaints are extensively advertised and are readily available. Since a visit to a practitioner is not required, popping a pill saves time and money. No doubt changing attitudes to conventional health care, and increased knowledge of health matters, also play a part. Trust in orthodox medicine has declined over the last thirty years. Press reports of medical negligence and malpractice, as well as the overuse of antibiotics, and their effects on the environment, suggest that orthodox medicine is less trustworthy than previously believed. Yet quite a few people happily trust long-used, traditional ‘natural’ remedies but as we will later discover such trust is not always justified.
Surveys have found that our reasons for buying pre-packaged medicines fall into two broad categories. The first is health maintenance or improvement: for extra energy or stamina, improved memory or mental agility, prevention or treatment of common illnesses like colds and flu or more serious illnesses, to slow down the aging process or to improve sexual function. It is difficult to be certain if any of those conditions are improved by OTC remedies, therefore it is not surprising that health maintenance and improvement is a mainstays of the diet supplement industry which thrives more on hope than effective performance. Since laws are in place to prevent claims of efficacy appearing on OTC labels, the characteristics of the people who are its greatest supporters do seem surprising. Australian and American surveys suggest that those who use OTC remedies are mostly females between the ages of 15 and 50. By comparison to non-users, they are more likely to be well-educated, have a higher economic status and a higher household income. So, it is mainly middle-class women who are filling the coffers of mineral and vitamin supplement manufacturers. Since these people are likely to be savvy consumers, they know that the biggest killers are cancer, heart conditions and strokes. Hence, they are concerned to maintain their health status by exercising, dieting and supplementing their diets with minerals and vitamins. Everyone wants to remain healthy, so instead of swallowing tonics as they did in previous centuries, they pop a pill and go to the gym.
Laudable as the pursuit of health maintenance is, high consumption of these items may not be necessary. The irony is that people living in western countries with a high living standard have ready access to balanced diets which provide the essential nutrients. The recommended dietary allowance (RDA) for minerals and vitamins has been set in the United States at a level which should meet the needs of ninety-seven to ninety-eight per cent of averagely healthy individuals. This level is aimed at decreasing the risk of chronic disease as well as normal health maintenance. Of course, there are groups of people who do need to supplement their diet with added vitamins and minerals. Patients recovering from major surgery or debilitating illnesses may benefit from added vitamins and minerals. Anyone who, for some reason, is unable to eat a balanced diet for a prolonged period is advised to use supplements. Artificially-fed infants and pregnant women usually require vitamin supplements. Those who are on a vegan diet may need supplements but vegetarians who eat a varied diet probably do not. Clearly different individuals have different requirements depending on their health status or age, but the perception that all and sundry require supplements is an artefact of advertising.
Another reason for self-medication is the treatment or reduction of symptoms such as anxiety, stress or depression, or to help women’s menopausal symptoms, or to treat or relieve symptoms such as the pain associated with some illnesses.[vi] Medicines to relieve allergies such as hay fever are also widely used. Some non-prescription drugs containing antihistamines can provide temporary relief but may cause drowsiness in susceptible people, so sometimes pseudoephedrine, which helps nose blockage and chest wheezing, is sometimes also added to counteract any sedative effect.
Other non-prescription medicines in wide use are pain-relievers such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). Aspirin (a derivative of the bark of the willow tree) has been known as a painkiller and antipyretic with an anti-inflammatory effect since 1763, along with other trees and plants contain salicylates, such as wintergreen, black cohosh root, poplar tree bark and sweet birch bark.[vii] Then in 1950 an English family doctor observed its anti-clotting properties and published several papers on the subject. Twenty years passed before his observation was taken up by a biochemist, John Vane, who won a Nobel Prize in 1982 for showing how aspirin discouraged small platelets in the blood from sticking to blood vessel walls, and each other, to form clots. Aspirin is now widely given in very small doses as a prophylactic against heart attacks and strokes. It is considered a safe drug with only two adverse effects. Aspirin should never be given to children under 16 as an antipyretic if they have a viral infection, because of the risk of Reye’s syndrome, a potentially fatal disease. Its usefulness for adults must also be measured against the risk. When high doses are used it can cause bleeding in the stomach that may be severe.
While attention has focussed on OTC pills, the internet now provides opportunities for self-medication that are virtually unlimited. Many prescription drugs considered harmful if used inappropriately are now available online through internet marketers. One online pharmacy lists over a hundred drugs including such items as isosorbide mononitrate (vasodilator), Prozac (treatment of depression and obsessive-compulsive disorder), beta-blockers (to reduce workload on the heart) and penicillin. A detailed description of each drug was given together with warnings about side effects. Purchasers fill in a health history questionnaire and are asked not to take any of the drugs purchased in this way without consulting a pharmacist.[viii] When I accessed this site I did not test whether a purchaser would be refused a supply of a drug if their health history suggested it was unsuitable or dangerous. Where a physician’s prescription is not required, online pharmacies are in direct competition with the conventional medical profession and with complementary and alternative therapists.
Many of the herbal remedies that homeopaths, naturopaths and herbalists include in their repertoire are available pre-packaged in retail outlets or via the internet. As a service to consumers, product labels list all the ailments each one is suitable for and give instructions for its use. So, purchasing remedies over-the-counter or online obviates the need for a consultation. However, consumers should be aware that some so-called homeopathic remedies are being formulated