Self-medication of over the counter drugs is very dangerous and could cause medical problems
31 October 2006
When people get at me about the lack of Over the Counter (OTC) sale of drugs in this country I wish it was about something as simple as emergency contraception. Here is an issue on which I could easily just say I think it should be available or not - it's much more difficult with the pharmaceutical products my friends and acquaintances are taking.
The latest example is aspirin. I was having a good time eating a large Italian dinner - for me a half portion of lasagne followed by prawns in white wine with garlic - when we got around to discussing health. I was the only medic present and the assembled company wanted to know why they had to get prescriptions for aspirin when everyone knows it is nothing but good for you. All seemed to be taking aspirin but some were self-prescribed and had got hold of it themselves either at home or abroad. There was one exception, a man who said he had to give it up after nearly bleeding to death a few years ago when he cut himself shaving. A blood transfusion was not needed but it all sounded most alarming.
Now, it just so happened that a few days before I had read an article in the July/August 2006 edition of the Irish Medical Journal by John Caird et al on "The Impact of Antithrombotic Therapy on Neurosurgical Emergency Referral Load" and had been most interested in their findings.
The article states that the study was undertaken to determine the impact of antithrombotic therapy on emergency referrals to one neurosurgical centre because, as they say in the introduction, "Catastrophic intracranial haemorrhage in patients on antithrobotic therapy seems to appear more and more frequently on our image link screens."
The concerns of the authors proved to be well founded after they had documented the 713 emergency referrals over a 90-day period to their unit in Beaumont Hospital. 174 patients presented with intracranial or spinal haemorrhage and 43 per cent of these were on antithrombotic therapy. 43 patients (47 per cent) were on aspirin alone and, of that 43, 17 patients (40 per cent) had no medical indication for aspirin therapy. In other words a sizable number of people had a very serious medical condition because they were on a drug they did not need. It is not stated if the drug was self administered or prescribed. The Beaumont team's article concludes with the following paragraph:-
While there are undoubted benefits of antithrombotic therapy for patients at risk of thrombo-embolic events, the haemorrhagic complications of such therapy outside the domain of randomised, prospective trials may be underestimated. In particular the practice of prescribing aspirin as primary prevention in hypertensive patients remains contentious and has not been supported by a randomised, prospective trial.
Aspirin is not regarded as a pharmaceutical product by many of the general public because, I suppose, it has been available for well over a century and is so easily acquired. There are probably very few people around now who remember the dreadful Reye's syndrome in children, brought on by this innocuous product as we thought. Remember junior aspirin. But aspirin is a very powerful drug and I would like to see a lot more public education on it. One of my dinner companions even said "But doesn't it prevent cancer?" That's as may be, but it can have adverse side effects, too.
This brings me to the altruism of Pfizer in setting up a stand at the National Ploughing Championships for the third year to do an epidemiological survey on the health of the farmers of Ireland. Health initiatives at such a venture are to be welcomed but it might be more advisable if they were run by the Health Service Executive or neutral charitable organisations such as the Irish Heart Foundation or the Irish Cancer society. Here I must declare an interest in having tried to promote the aims of both organisations to the general public. In the case of the Irish Cancer Society I went to the Ploughing Championships years ago to speak on the subject of breast cancer. Pfizer is a fine firm and a good employer, but is it suitable to have drug companies so closely associated with such projects?
Newspaper reports about the farmers' health survey that was conducted were very worrying. About 10 per cent of those who were screened (120 people) required immediate emergency referral. 10 per cent of people had raised glucose levels. High blood pressure was a particular problem and 45 per cent of those screened were reported to have high cholesterol readings. These could not have been fasting cholesterols as is recommended, so let us hope not all were immediately put on statins.
Statins were popular with my friends at dinner, too, and mindful of the instructions given in the EU Cardiovascular strategy about recommending change of life style for three months before starting treatment with statins, I asked if this had been recommended to any of them. (By this stage we were on to puddings and cheese - Zabaglione and Bel Paese - delicious). Not one affirmative answer!
The HSE has begun asking doctors to declare any conflicts of interest, financial for example, they may have that could influence or impinge on their practice of medicine. In view of this I, like Dr Martin Daly who chairs the IMO GP's committee, was somewhat surprised to see that the HSE had accepted the support of the pharmaceutical industry to disseminate information on primary care. A drugs company (Pfizer again) will host a meeting for GPs in Galway at which the main speaker will be Dr Sean Maguire, special advisor to HSE CEO Professor Brendan Drumm. A meal will follow the meeting. Ho, ho, ho. I thought we all had been warned about no such thing as a free dinner a long time ago. A similar meeting apparently took place in Mayo in March. Is this part of privatising the Health Service?
Senator Mary Henry, MD
