The Expanding Place Of Selfmedication

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In recent years, the role of over-the-counter (OTC) medication in the overall health system has increased dramatically. The increased interest in and availability of OTC medications is being driven by several factors:

1. There is a growing recognition of the capability of patients to treat themselves in a rational and safe manner. The older authoritarian model of medicine is being gradually replaced by a more participative model.

2. There is an increasing desire by patients to participate in their own medical care. This is not just a result of changes in philosophy but also of the dramatic increase in average educational level over the past half-century. The world increasingly possesses a well-informed and intellectually capable population that demands an active and inclusive role in its own health care.

3. The quantity of information now available to the average person, both through formal education and through the media, has increased enormously, giving increasing awareness of treatment options.

4. There is a growing need to contain medical costs. OTC drugs are not only cheaper than prescription drugs, due to their simpler and more efficient distribution channels, but they also eliminate the need for an expensive visit with the doctor for each episode of illness. The professional intervention required to prescribe pharmaceuticals represents the dominant cost in the handling of many common types of illness.

5. There is a need to increase treatment effectiveness, which is not ordinarily considered an advantage of self-medication. The increase in effectiveness depends on the generally more rapid availability of OTC medications than prescription medications, so that treatment may begin sooner. This can significantly shorten the total length of suffering, especially when the natural course of a disease is brief or when severe discomfort makes prompt therapy especially helpful.

An example of this last phenomenon is in the treatment of vaginal candidiasis. Prior to the OTC availability of topical antifungals, it was often necessary for a woman who had already recognized the symptoms of the disease to call and arrange a physician's appointment. This often took several days. Delaying treatment caused much unnecessary suffering and encouraged disease progression. Many physicians, recognizing these difficulties, would prescribe over the phone, based solely on the woman's description of symptoms. Research has shown that the accuracy of the physician's diagnosis in this setting is no better than that of the woman herself. This constituted an ideal situation for the switching of an important class of drugs from prescription to OTC status. The patient obtained equally accurate diagnosis and far more rapid treatment for a disease that is very uncomfortable. Severe cases of vaginal candidiasis with heavy discharge are now much less common.

A second example is in the treatment of the common cold. Anti-cold medications have been available OTC for many years, because of the compelling need for rapid treatment. A cold evolves quickly, the entire illness lasting only a few days. A delay of only a day or two in seeing the physician for a prescription may eliminate any possibility of obtaining effective treatment for at least half of the duration of the illness. The prompt availability of self-medication improves treatment efficacy, while reducing costs and enhancing patient satisfaction with the medical system.

The above factors have combined to greatly increase public awareness of the importance of self-medication in the total health care scheme. The pharmaceutical physician should recognize the opportunities for OTC use of medications and the advantages and pitfalls attendant upon such use. As self-medication becomes a central part of the health care system, the skillful and appropriate movement of pharmaceuticals from prescription to OTC availability will increasingly become a vital role of the pharmaceutical physician in optimizing the nation's health.

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