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| Sunday, 7 December 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Self medication - an emerging trend Dr. SIMON FRADD, a Principal in General Practice in Nottingham and the Joint Deputy Chairman of the General Practitioners Committee (GPC) of the British medical Association as well as Chairman of Doctor-Patient Partnerships, was in Sri Lanka recently at the invitation of Glaxo SmithKline. He spoke to Sunday Observer Staffer CAROL ALOYSIUS
A: In the USA I think over 75 per cent self medicate. In the UK it is 100 percent, i.e. everybody resorts to self medication at some time or another initially, instead of running to a hospital or clinic at the first start of a cold or fever. Q: Why? A: Because it is more convenient for them and less costly. If they know for example that they can get the right medicines for a cold or fever over the counter at a pharmacy and be able to treat themselves at home, why waste time standing in queues at hospitals? Q: How did the general public become aware that they had the option to self medicate if they wished in the case of minor ailments? Do they have free and easy access to treating these ailments? A: The general public began realising they could self medicate with the drugs we provided for them at the pharmacies about 20 years ago, when we first began our awareness raising programs. Due to the availability of a very wide range of drugs over the counter (OTC), people are now able to treat more of their own illnesses including pain management and chronic conditions with prescribed pills, thus reducing pressure on medical services. Q: What are the direct benefits to patients by self medication? A: They have direct access to effective, reliable and safe medicines. We have made it a point to flood the market with a greater variety of safe medicines that a person can take without harmful side effects, at home. So they have greater choice of treatment. Instead of having to rely only on the treatment the doctor gives, they can find something that suits them better. It is also more convenient for them as it cuts out the hassle of visits to a doctor. So it saves the patient's and doctor's time, and most importantly, improves education and knowledge about health in the community. It also empowers the individual to take decisions regarding health management and be self reliant. Q: How does the state benefit from this new trend? A: Since less patients are visiting hospitals now, it is possible for the health services to release resources for use in other areas of health care A trend we see in many European countries in recent years is that there are fewer consultations for minor ailments. Now we have approximately 46 per cent less GP visits in UK. In Sweden which has switched as much as 16 drugs to OTC (over the Counter) the health system has in the past two years saved 30 million dollars. The same thing is happening in the US where an annual 20 billion US dollars is being saved, following fewer consultations. Q: Isn't there a danger of incorrect self diagnosis and drug misuse as well as delayed treatments of serious conditions as a result of self medication? A: This charge has been levelled often against self medication. But from reports we have had so far, there is no significant increase in drug misuse or incorrect diagnosis or delays in getting treatment for serious illnesses, because patients are now much more aware of their illnesses than before. If they are really sick they would definitely seek medical help. Our experience is that people don't overdose just because the drugs are available. To cite an example, we developed the drug Cimetidine for indigestion and the doctors were against the idea of putting this drug over the counter fearing that people could overdose as it was a powerful drug which could veil the existence of stomach cancer if a patient had the disease. But significantly we have had no increase of stomach cancer related to the drug being made OTC which goes to show that people now know how much they should or shouldn't take. Q: So does this mean you will be making more drugs available over the counters in the future? A: Definitely. Q: Has this anything to do with public demand? A: Certainly. Today, the public wants and demands a greater range of drugs that they can buy over the counter at any pharmacy, so that they can switch from stronger drugs to milder ones depending on the severity of their ailment. For e.g. if we talk about pain killers, they now can choose one drug for headaches and one for arm aches like Panadol and Codeine. If they did not have the choice they would end up taking too many Panadols. Q: There have been a lot of adverse reports of taking too many panadols. What is your opinion about this? A: I say that people have got into a panic for no reason. The only thing to worry about is giving adult Panadols to children under 12 years. I say, 'don't give children under 12 years, the same kind of Panadol that you give an adult. That is dangerous. Yet some parents I know still crush a tablet of panadol which is used for adults, and force their children to swallow it hoping that the child's fever or pain will go away quickly. This is dangerous I repeat. For children under 12 years we have developed a special panadol syrup given with a measuring spoon packed in a sachet. Ideally it should be a single dose sold in a single sachet over the counter so that it is affordable to all. Q: What do you see as a special benefit for doctors as an outcome of the trend towards self medication? A: I say it allows the doctor to maintain his professional credibility. Instead of having to spend most of his time attending to minor ailments he can now examine patients with more serious illnesses. Q: Do you foresee more drugs being made OTC for chronic illnesses? What are the emerging trends in this regard? A: Yes, we are putting out drugs for stable asthma, stable angina, hypertension, chronic pulmonary disease, obesity, anxiety, post menopausal osteoporosis, erectile dysfunction and oral fungal infections. We at Doctor-patient partnerships are also increasing emphasis on patient's self management of pain. Eg. headaches, migraine, dental pain, musculo-skeletal pain. In fact pain relief represents 17 per cent of OTC sales in europe. We also believe in combination products which we consider a key element in successful treatment. Q: What are your treatment options? A: Paracetamol. Non steroidal anti-inflammatory drugs, ibupfofen, aspirin. Q: And what is the overall message you wish to convey from this discussion? A: Give patients a wider selection of drugs they can access easily over the counter. They want stronger faster pain relief drugs, they want more control over their own bodies and illnesses and they want to be self reliant. My overall message is that promoting responsible self medication is a key element in any long term health policy. ####### Hands that heal 'Hands that heal' is by no means a new concept. Today however it is considered a science which is based largely on accupressure, and draws its power from cosmic energy.
Proof of this remarkable ability was evident when we visited his small hotel room recently when he was on a brief visit to Sri Lanka. Sitting on a bed cluttered with heaps of cuttings from newspapers and magazines, not forgetting an article on him in USA's reputed `Who's Who in the world' almanac- Dr. Shashikant Seth demonstrated to us how he tapped the energy from the universe in order to transfer it to a patient in need of help. He cups his hands with both palms held upwards as if in prayer and says," "When I touch a patient with my hands containing this energy, the disturbed energy caused by illness, infection or an accident goes out of him and the good energy from my hands gets into his body and begin its healing process immediately". Having practised this technique which he says he learned from a reputed Japanese doctor, and is based on the accupressure points, he claims that over the past 25 years he has used it to cure seemingly incurable illnesses like cancer, chronic malaria, asthma, bone TB, arthritis, depression, frozen shoulder and heart disease. "I have had specially good results for frozen shoulder and arthritis and blocked heart" he says. We talk to two patients one with arthritis and the other who has a frozen shoulder healed recently, who confirm that the touch healing method has done "wonders" to them. "I could barely walk says Agnes 72 who has been touched by Dr. Seth for the past three months and is now able to walk with hardly any pain." The second patient who has a frozen shoulder and had been unable to raise his hands for five months demonstrated how his hand had been completely healed. "These are no miracle cures and I'm no miracle healer. All I'm doing is trapping the energy from the universe into these hands and passing the good rays through my body to my patients" Dr. Seth says. Each healing session is usually followed up with a specially drawn diet sheet custom tailored for the patient. "Diet control (a pure vegetarian diet is the best) and meditation as well as exercises are all part of the healing process", he emphasises. For malaria patients Dr. Seth has developed a herbal medicine for both prevention and treatment of the disease for which he was presented the 'Hind Ratan' award by the then President Dr. Shankar Dayal Sharma. "Natural herbs obtained from jungles and mixed with milk are the only ingredients I use. There are absolutely no side effects because they are hundred percent natural". Dr. Seth has set up the natural Healers' Association International since his fame has spread beyond his native India. He now visits several countries including Sri Lanka on a regular basis. He can be contacted on his e-mail: [email protected] - (C.A.) ####### Too poor, too many children : Is abortion the answer ? Unsafe abortion has become a major health issue, says DR. RUVAIZ HANIFFA Abortion is a major cause of morbidity and mortality in Sri Lanka, affecting the reproductive and general health of women and finally the quality of life of women and the family.
Abortion is defined as the expulsion of products of conception before 28 weeks of gestation. It could broadly divided in to two groups; Spontaneous Abortions - Occurs naturally. Due to inability of the foetus to Exist within the uterus. These could broadly due to Maternal factors (e.g. Structural abnormalities of the uterus or Foetal factors (e.g. Genetic Abnormalities) Spontaneous abortions usually occur within the first 12 weeks of gestation. Induced Abortions - Occurs due to intentional or unintentional interference with the pregnancy. The majority of these abortions are done under unhygienic unsterile conditions, and often by non-medical people. This is the major cause for the high morbidity and mortality rates following an abortion. Some major concerns with such abortions are: (a) Septic abortion (b) Septicaemia (c) Chronic sequels - pelvic inflammatory diseases, sterility (d)Death According to a recent survey the main reasons for seeking abortion among Sri Lanka Sri Lanka women were as follows: 1. Youngest child too small (27.3 percent) 2. Completed family (7 percent) 3. Poverty (13.2 percent) 4. Local or foreign employment (14.6 percent) 5. Children are adults (7 percent) 6. Unmarried (2.5 percent) The majority (96 percent) of abortions in Sri Lanka occur among married women. Unmarried women constitute only a minority of those seeking abortions in Sri Lanka. The single most important factor for abortion in Sri Lanka is the unmet need for contraception. In other words women in Sri Lanka are using the currently illegal practice of abortion as a front line contraceptive method. The tragedy is that by resorting to this illegal practice they are jeopardising their health and quality of life. The male input towards persuading or dissuading women towards abortion is at present unknown. Currently the Government of Sri Lanka is considering legalising abortion for specific reasons. The reasons are 1. Genetic abnormalities of the foetus 2. Conception following rape 3. Conception following incest Unfortunately, the reasons for which the government is considering legalising abortions are not the reasons for which women are seeking abortions in Sri Lanka. The reasons for which the government wants to legalise abortions do not even figure in the list of reasons for which women seek abortions. Thus legalisation for the said reasons will have no impact on the practice of illegal induced abortions. So, then why does the government want to legalise abortion in Sri Lanka ? By legalisation of abortion the government hopes that abortions (for defined reasons) will be performed in a more regulated environment using proper surgical equipment and techniques by a competent medical team. This the government hopes will result in a reduction in abortion associated morbidity and mortality. But mere legalisation on paper will not solve the problem. There will have to be corresponding health infrastructure developments in the government sector to accommodate and sustain this service the government proposes to offer. Some such infrastructure developments which will have to precede the legalisation of abortion would be; 1. Increasing operation theatre facilities 2. Training and equitable distribution of medical personnel (this includes surgeons, anaesthetists, medical officers, nurses, midwives, theatre assistants and medical administrators) 3. Improving access to and strengthening antenatal genetic screening services 4. Commitment of health and other authorities towards sustainability of the programme. (Includes political commitment) 5. Willingness of health and law enforcement authorities to shut down already well established illegal abortion facilities. One must also and always consider the ethical, moral and social issues that are interwoven with the issue of abortion. Past experience shows that public opinion in Sri Lanka has always been overwhelmingly anti-abortional. Legalisation will require an act of parliament to become law. Given the present scenario such legislation may provoke a guest deal of emotional public opposition.On the other hand what of the genuine need of a women to have an abortion for reasons of genetic abnormality of the foetus or conception following rape or incest ? These women though a statistical minority do have a genuine right to campaign for legalisation of abortions for the said reasons. In arriving at a final solution (which has eluded many a nation before us) we should remember that, "What is right may not always be moral and what is moral may not always be right". Thus in arriving at a consensus the views of this statistical minority should also be adequately heard and taken note of. This would ensure that their legal rights will be accommodated without the need to compromise their health and quality of life in the Sri Lankan context. (Adapted from correspondence published in the Ceylon Medical Journal Volume 48, No. 3, September 2003) ####### Pre-natal triple test now in Sri Lanka Pre-natal Triple Test measures relevant serum levels in the mother's blood to determine whether the foetus could suffer from Down Syndrome, which implies mental retardation, cognitive disability or other development delays. Some of the common physical traits associated with Down Syndrom include folds over the eyes, flattened bridge of the nose and decreased muscle tone.Upto now, for this Triple Test, mothers' blood samples had to be sent to USA. Testing in USA is expensive and it takes a long time to get the results. Now, Asiri Hospital performs this Triple Test and the results are made available within a couple of days. The Triple Test requires a blood sample from the mother taken between week 14 and 22 of the pregnancy.Asiri uses kits approved by FDA (Food and Drug Administration in USA) for these three tests (human chorionic gonadotropin - hCG, maternal serum alpha-fetoprotein - MSAFP, and unconjugated estriol). They are done on a fully automated chemi luminescent immuno analyzer. The three results have to be adjusted to the mother's individual profile by a computer program to give an estimate of the risk of having a foetus with Down Syndrome.Asiri uses a sophisticated computer program specially developed for them in Germany to correlate the results to the mother's personal data such as age, duration of pregnancy, ethnic origin, weight, etc. Before the Triple Test is done, a consent form has to be filled in. The pregnant mother, her doctor, or a senior laboratory person at the Asiri Hospital can do this. |
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Q: What is the estimated number of people in the USA and UK, who
believe in this kind of medication, to avoid going to a hospital when they
have fever or cold or a more serious illness?
Dr. Shashikant
Seth, has for more than a quarter century been applying
his healing touch to hundreds of patients suffering from various diseases
- with positive results.
The health system in particular and society in general are still to
recognize the importance of this public health problem. At present
abortion in Sri Lanka is illegal for any reason other than when maternal
life is in danger. But the illegal status of abortion has in no way
deterred women from seeking it. It is estimated that 44.7 per 1000 women
aged 15 to 49 years have abortions each year in Sri Lanka. Calculated for
a day this works out to a staggering 658 abortions per day.
