Self-medication

Factors promoting and inhibiting the reclassification of drugs to pharmacy status (from: Blenkinsopp & Bradley. (1996) Over the Counter Drugs: Patients, society, and the increase in self medication) Promoters: Patient empowerment (increase in the autonomy ethic) Rise of consumerism Decreasing power of the professions Changing balance of power within the professions Pharmacists' drive to extend their role Government policy to contain the NHS drugs bill Possible influence of (other) health care systems Pharmaceutical companies' wish to protect profits Inhibitors: Professionals' protection of their domain Doubts about patients' competence in self care Pharmacists' anxieties about increased responsibility

Self-medication is a growing trend reflecting an evolution of various societal factors.

Basic determinants

Although the decision to allow the OTC distribution of a drug depends on several factors (see box), basic considerations must include safety, efficacy and feasibility (the person must be able to self-prescribe without undue risk of misdiagnosis).

Uncharacterized treatments

The definition of self-medication is closely dependent on the definition of a drug. The public may as well use compounds other than over-the-counter (OTC) drugs, also called natural health remedies, biological therapies, traditional treatments, which are not necessarily treated as medications, due to their generally different safety profile and to the fact that they are not part of the "innovation pipeline". Safety concerns will determine if these medications enter into the medical jurisdiction.

Feasibility

The status of self-medication also depends on the availability of medical care. If a drug is, for financial reasons, more easily accessible than the cares of the professional who would ideally prescribe this drug, then self-medication can be medically justified, in accordance with the WMA's declaration of Helsinki, although it is not in principle a justification of self-prescription.

Self-medication as a moral imperative

Self-medication can also be conceived as a fundamental right bypassing such rights as private property and intellectual property. As was reflected in Kohlberg's famous dillema, the decision to rob the inventor of an anti-cancer drug and medicate a loved one because the treatment is not otherwise affordable can be viewed as a morally superior act, while the choice to respect authority, and the financial constraints imposed by the inventor of the drug, could be judged immature (because it is based on societal conformism).

Heinz Steals the Drug In Europe, a woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to make. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman's husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $ 1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: "No, I discovered the drug and I'm going to make money from it." So Heinz got desperate and broke into the man's store to steal the drug-for his wife. Should the husband have done that? (Kohlberg, 1963)

Dangers of self-medication

Self-medication can be promoted by private interests to the disadvantage of the population. The Alliance for the prudent use of antibiotics as well as several investigators urge non-physicians to use extreme care in their use of antibiotics, because unappropriate use of antibiotics lead to antibiotic resistance.

The careless use of common OTC drugs, such as pain relievers and antipyretics, may as well cause a sizable number of premature deaths.

(in progress)