The practice of self-medication is so prevalent in our society that there is hardly any one, who has not experienced it directly or indirectly. This practice is strongly fueled by several factors such as urge to alleviate suffering, help other family members, poverty, ignorance and poor medical access. Moreover, in a country like India, where there is disproportionate growth of retail pharmacies with limited regulatory monitoring, this practice is all the more pervasive.
Self-medication can be defined as a use of medicines by a person in order to treat a perceived health problem without consulting an authorized medical professional. However, the 'World Self-medication Industry' (WSMI) defines self-medication as a treatment for common health problems with medicines designed and labelled for use without medical supervision and approved as safe. Although, this definition takes into consideration the presence of a strong regulatory policy, which identifies the suitable medicines for self-medication, it strongly emphasizes the most important aspect of self-medication as being safety and efficacy.
In this context, let us try and explore the practice of self-medication in our society. The various studies among the population have identified several reasons for this practice. Some of them are:
S- Savings (money)
T- Time factor
E- Education (more educated more self medication)
P- Peers
U- Urgent (immediate relief)
P- Protection (morning after pills, post coital pills)
Many of these reasons are self explanatory and intuitive. However, reasons may be different among the rural and urban population. In a study of rural Maharashtra, Phalke et al has identified the prevalence of self-medication to be 82 per cent (one of the highest reported). Also, it is interesting that 42 per cent of their interviewees were illiterates, while 58 per cent of the respondents attributed this practice to economic reasons and another 30 per cent to poor medical access. Interestingly, the majority of drug procurement happened from a grocery shop or pan shop (54 per cent). However, the silver lining was that 80 per cent of self-medications were for minor illnesses such as headache, cough and fever.
In comparison, the urban population showed a similar prevalence of 70 to 80 per cent. The reasons for self-medication were poor access to medical care (44 per cent), economics (52 per cent), time factor (22 per cent), and prevailing notions (30 per cent). Importantly, 54 per cent obtained the information regarding self-medication/drugs from chemists and paramedics.
The awareness of the drug interactions, adverse effects and appropriate dosing is abysmal whether it is rural or urban.
The six D's outline the issues that can cause an undesirable outcome.
A) Dose (Over or Under)
B) Drug interaction
C) Drug resistance
D) Delayed diagnosis
E) Detrimental effects
F) Death
Improper dosing may not be efficacious and can result in poisoning even if a normal dose is used, for example, in pediatric age groups and older patients with renal insufficiency. In this day and age, where every adult is on some combination of medications, which is difficult even for a medical professional to keep track, imagine doling out medicines without being aware of drug interactions. Also, this leads to delay in medical attention apart from creating resistance to certain drugs and invariably leading to prolonged and critical hospitalizations (equals economic loss).
Concept of responsible self-medication
Conceptually, self-medication is a good option provided strict guidelines and regulations are established and administered. There are examples that can provide a construct to develop these guidelines (WSMI). First of all, self-medication should be recognized as a problem and one that has to be accepted and properly dealt with. One possibility is the concept of 'responsible self-medication'. This should be accomplished by proper education via media and literature. To take the cue from western countries and separate the drugs as prescription and non-prescription with proper labelling and educational material that should be issued with the medicines. In India, regulatory agencies have different schedules for different drugs, which are not practical and don't take into account the prevalent use in the society. These schedules for the drugs have to be constantly reevaluated and reclassified, while adverse event reporting should be mandatory.
Even though, pharmacies have to be run by a qualified pharmacist in order to obtain the licence, the reality is far from the truth. Many of these pharmacies are run by unqualified people, who are more than willing to don the garb of a doctor or a qualified pharmacist. It is in the best interest of the future pharmacist that we do not allow unqualified people manning the pharmacies. With ever decreasing trust on the medical professionals and increasing awareness towards litigation, positioning the pharmacist and pharmaceutical companies in a socially responsible light is important.
To differentiate and encourage responsible pharmacies, which are manned by qualified pharmacists, added incentives are necessary and prudent. Also, the need for qualified pharmacists both in the hospitals and retail pharmacies to decrease medication errors is ever increasing. With newer rules and regulations, the legitimacy and pride of being a pharmacist would increase the demand for institutions administering pharmacy courses.
Although, self-medication has been encouraged by WHO and other health organizations, in order to improve medical access and affordability in developing countries, the practical grass root propaganda should be accompanied by proper education of the safety and efficacy. In sum, a combination of pharmacovigilance, community education and greater availability of qualified pharmacists would make our society and the practice of self-medication safer.
(The author is senior consultant pediatric cardiologist, Apollo Hospital, Hyderabad)