E-drug: self medication policies, guidelines, EDL? (cont'd)
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Eve and Kim,
I was being deliberately provocative for fun. However there is a
serious side. ORS (in the my situation 1 glass lemonade 3 glasses
of water), paracetamol and aspirin are the only self medications my
family ever uses.
I apologise for forgetting to mention community pharmacists. When
we first had worms and later when we first had head lice we asked
our local pharmacist for advice re what medication to take. I did not
classify this as self medication because we asked a health
professional for advice. I concede that it could be considered self
medication when we got more later with out requesting advice.
I worry about the community pharmacists' conflict of interest in
giving advice. If they got the same profit on any item then I would
feel more trust. However I think it would be unreasonable to expect
them to always give the best advice re not using drugs when drugs
are less appropriate. Not because of dishonesty but because it is
normal for people to believe that what is in their own interests is
true or justified. Consequently it is only to be expected that the
pharmacist did recommend a drug for the head lice despite the fact
that it is probably toxic and rarely effective. Good advice about the
effective non drug treatment (frequent shampoo and fine combing)
would have saved us a lot of time and money.
I accept that doctors like me have conflicts of interest also eg when
we accept gifts etc from vested interests.
Kim has done the correct thing to disclose his conflict of interest.
He has a valuable point if he is talking about situations where an
expensive consultation with a doctor is not necessary. In parts of
the world where doctors are difficult to access then self medication
may make more sense but for each drug it would be good to see
evidence that the benefits are greater than the harms and costs of
inappropriate use. I concede that if doctors' advice is often wrong
then people may be better off without seeing doctors.
I am open to the idea that as Kim suggests "In addition, a number
of medications available for self-medication can reduce the severity
or progression of an illness and even reduce opportunistic
secondary infection."
I invite Kim or anyone else to propose specific "self medication"
drugs that deserve to be added to the list and provide evidence that
the benefits outweigh the harms enough to justify the costs.
regards,
Peter
Dr Peter Mansfield
GP and consultant on marketing and appropriate therapeutics.
Visiting lecturer, Universities of Adelaide, Flinders, Queensland,
South Australia, Tasmania
Action against cardiovascular Risk Checklist (ARC) Project Officer,
Adelaide Western Division of General Practice
Director, HealthySkepticism.org formerly MaLAM (Medical Lobby
for Appropriate Marketing)
Defending health care from misleading and harmful marketing.
Advocacy, Research and Education.
peter@healthyskepticism.org
www.healthyskepticism.org
34 Methodist St, Willunga SA 5172
ph/fax +61 8 8374 2245
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