14 The Unique Role of

Over-the-Counter Medicine

Paul Starkey

14.1 The expanding place

of self-medication

In recent years, the role of over-the-counter (OTC)
medication in the overall health system has
increased dramatically. The increased interest in
and availability of OTC medications is being dri-
ven by several factors:

1. There is a growing recognition of the capability
   of patients to treat themselves in a rational and
   safe manner. The older authoritarian model of
   medicine is being gradually replaced by a more
   participative model.


2. There is an increasing desire by patients to
   participate in their own medical care. This is
   not just a result of changes in philosophy but
   also of the dramatic increase in average educa-
   tionallevelover the pasthalf-century. Theworld
   increasingly possesses a well-informed and
   intellectually capable population that demands
   an active and inclusive role in its own
   healthcare.


3. The quantity of information now available to
   the average person, both through formal educa-
   tion and through the media, has increased

substantially, giving increasing awareness of

treatment options.

4. There is a growing need to contain medical
   costs. OTC drugs are not only cheaper than
   prescription drugs, due to their simpler and
   more efficient distribution channels, but they
   also eliminate the need for an expensive visit
   to the doctor for each episode of illness. The
   professional intervention required to prescribe
   pharmaceuticals represents the dominant cost
   in the handling of many common types of
   illness.


5. There is a need to increase treatment effective-
   ness, which is not ordinarily considered an
   advantage of self-medication. Increase in effec-
   tiveness depends on the generally more rapid
   availability of OTC medications compared to
   prescription medications, so that treatment may
   begin sooner. This can significantly shorten the
   total length of suffering, especially when the
   natural course of a disease is brief or when
   severe discomfort makes prompt therapy espe-
   cially helpful.

An example of this last phenomenon is in the

treatment of vaginal candidiasis. Prior to the OTC

Principles and Practice of Pharmaceutical Medicine, 2nd Edition Edited by L. D. Edwards, A. J. Fletcher, A. W. Fox and P. D. Stonier
#2007 John Wiley & Sons, Ltd ISBN: 978-0-470-09313-9