Since the start of the Covid-19 pandemic, the message has been clear: while people should seek medical attention in serious cases, they should otherwise self-isolate and tend to their symptoms at home. This strategy, devised to ease the burden on healthcare systems, has led to many people stocking up on paracetamol, ibuprofen, and other forms of over-the-counter (OTC) symptom relief.
At the same time, people suffering non-Covid-related health complaints have been more likely to reconsider whether they really need to see a doctor. According to a study published in November, which looked at more than five million Americans’ medical records, healthcare visits dropped by 23% in March and 52% in April, compared to the same period in 2018 and 2019. While telemedicine visits rose by 4,000%, these online appointments only made up about 40% of the shortfall.
Considering the number of vital appointments that were missed (think colonoscopies, mammograms etc) this trend is a cause for concern. However, the discussion around self-medication is a nuanced one. In many instances, self-treating minor ailments can ensure the proper allocation of healthcare resources.
“Self care has major benefits for individuals and for society as a whole,” says Michelle Riddalls, CEO of PAGB, the UK consumer healthcare association. “For example, if you have a headache or a cold or a sore throat, in most cases you don’t need to see a doctor. If you visit a pharmacy as a first port of call, you avoid taking a slot at your GP surgery that someone else could use for a more urgent or serious health problem.”
The growing trend towards ‘self-care’
Self-medication was commonplace in many countries even prior to the pandemic. According to the US Consumer Healthcare Products Association (CHPA), 81% of adults use OTC medicines as a treatment for minor illnesses, while the OTC drugs market is growing rapidly, especially in emerging markets. However, Covid-19 has shifted the terms of the discussion.
“Our survey back in June found that during the pandemic, people in the UK became more willing and more likely to self care for minor ailments, either because they felt safer staying away from healthcare delivery settings or because they were aware of the pressure the NHS was under, or a mixture of both,” says Riddalls. “In fact, almost seven out of ten people (69%) in the UK who wouldn’t have considered self care as a first option said they were more likely to do so in the wake of the pandemic. Overall, almost a quarter (24%) said Covid-19 had changed their attitude to self care.”
In the same survey, 44% of respondents said they were more likely than before to look up their symptoms on the internet, while 77% said the NHS should make more information about self care available online.
Though the specifics vary from country to country, the trend is similar across geographies. In October, the Middle East, North Africa and Pakistan Self-Medication Industry (MENAP-SMI) revealed there had been a rise in ‘self care’ across the region, prompted by the Covid-19 crisis. Chairman Ashraf Allam stated that while patients benefit from being active participants in their own healthcare, the industry needed stricter regulation.
“That healthcare systems as well as individuals benefit from self-medication emphasises the need for clear policies by national governments,” he said. “Those policies should recognise the positive role played by products specifically intended for self-medication and they should protect their citizens’ preferences for taking an active role in their own health.”
Problems associated with self-medication
It’s clear to see why regulation is needed. In India, where there is still no defined regulation for OTC drugs, there have been reports of people self-medicating with experimental medicines like hydroxychloroquine.
These types of medicines, which are often acquired without prescription, have not been shown definitively to treat Covid-19, and can lead to complications. The US FDA, in fact, has declared the use of hydroxychloroquine as being unsafe for treating mild-to-moderate Covid-19.There is also a problem with antibiotics misuse in many developing countries, where antibiotics are available over the counter. As well as being an inappropriate choice of medication in many cases, this is fuelling the spread of antimicrobial resistance.
In some cases, self-medication carries a risk of dependency, especially where the drug is capable of causing tolerance and withdrawal. Painkillers containing codeine are a good example. Confronted with reports of ‘codeine addiction’, some countries introduced regulatory changes limiting these drugs’ availability.
However, it seems that the trend towards more self-medication is here to stay. The division between different healthcare types has never been set in stone, and it continues to blur. In the US, for example, many OTC drugs started out as prescription-only, but became OTC when they went off patent in a bid to increase product sales.
What might responsible self-medication look like?
So how can policymakers ensure self-medication is undertaken safely, and everyone has the necessary tools to treat their minor ailments effectively?
“We can’t expect people to know instinctively when they need to see a doctor and when it would be better to self care,” points out Riddalls. “That’s why we’d like see the introduction of a national self care strategy in the UK, as well as innovations like self care education in schools and an enhanced role for community pharmacy teams who can do so much to help people self care.”
In practice, this might mean giving pharmacists access to people’s medical records, and the ability to refer individuals to another healthcare professional if they believe someone’s symptoms warrant further investigation. Conversely, online NHS triage systems should signpost towards pharmacies where appropriate, rather than connecting the patient with a GP.
“If you could walk into your community pharmacy knowing you would come out with expert advice, an effective over-the-counter product or an appointment for medical help elsewhere, it becomes a much more appealing and efficient first choice,” says Riddalls. “It also frees up resources elsewhere in the NHS so that those whose symptoms need further investigating, or who are experiencing long-term or serious health conditions, have access to the care and treatment they need.”
It will also be imperative to set up clearer lines of communication between patients and the pharma companies. As the healthcare sector becomes more consumer-driven, we may end up seeing more resources like DrugsDisclosed.com, a platform collating patients’ reviews on their medications.
“Medicines safety demands that patients are listened to,” says Claus Møldrup, co-founder. “Currently, however, there are few mechanisms for them to feed back real-world experiences to the pharma companies that developed – and continue to develop – their medications. As data is democratised and patient voices become louder, the pharma industry must listen.”
The future of self-medication
In terms of where the self-medication sector is heading, Riddalls expects to see further changes driven by the rise of digital health. Already, there is a proliferation of health-oriented apps and wearables on the market, the majority of which are geared around managing long-term health conditions or improving wellbeing more generally.
“At PAGB we believe there is scope to harness more of this technology to encourage self care for minor health conditions,” she says. “That should include the development by the NHS of more online symptom checkers for self-treatable health problems, like the one it developed for the symptoms of Covid-19. We’d like the NHS to offer a clear online gateway to quality-assured information – and apps – about self-treatable ailments.”
Digital health solutions are important in developing countries too. MENAP-SMI’s Ashraf Allam stressed that building a framework for digital care services tailored to consumer needs could result in more sustainable healthcare systems, and that public awareness and engagement was crucial.
Meanwhile, it will fall to the pharma industry to adapt to patients’ changing needs, providing more comprehensive information about their products and truly following through with their rhetoric about ‘patient-centricity’.