Don't treat yourself
By `experimenting' with medication in an attempt to treat oneself, the danger lies in having to deal with side-effects and developing resistance to a disease, says Dr. K.P. PARTHASARATHY.
Medicine is ever-changing. Hence, self-medication must be discouraged.
"The preservation of health is a duty. Few seem conscious that there is such a thing as physical morality".
Most drugs which are bought from a pharmacy carry a label like this:
Warning: To be sold by retail on the presecription of a Registered Medical Practitioner only.
IT is ludicrous to find that many households practise a methodology/follow a pattern in taking care of the sick at home. Fever, cough, cold or body ache and one starts off with paracetamol (Crocin, Calpol) tablets or ibuprofen plus a paracetamol combination (Imol, Combiflam) and now of course the controversial nimesulide along with an antibiotic (ciprofloxacin, erythromycin) and an anti-histamine (Avil, Actified). This masala concoction of medicines has no rationale. To top it all, this form of self-medication is continued once or twice a day as per the instructions of a medical shop boy who is either a standard five or eight dropout, and, by power of observation, assumes the role of a medical practitioner. His expertise in memorising the trade and generic names of various drugs is exceptionally good and he develops combinations of drugs which forms a panacea for a doctor-wary customer.
Why is this malady prevalent in our country? While most developed countries have put in place a system of controls in the practice of medicine, in India, we have a stringent pharmacy act, but a lack of accountability on the part of the implementing machinery. Corrupt practices dilute the gamut of restrictions and the fear of punishment. We are in an age of defensive medical practice with litigations and a plethora of limitations restricting our freedom to practise scientific and ethical medicine. Thereby, the cost of medical treatment tends to skyrocket. Here we have medical insurance in its infancy. Many a time, patients are unaware of the intricacies of the insurance policy. Their unending stress and anguish start when they try to get a claim processed. Most patients have to fund the entire cost of treatment. These are the days of hectic commitment on the work front, with a fear of unending retribution. Succour lies then in the form of a medical shop personnel.
Self-administration of painkillers or fever reducing tablets like paracetamol is absolutely acceptable in an emergency. Addition of an antibiotic or other stronger drugs like non-steroidal anti-inflammatory drugs (NSAID) should be deprecated. Antibiotics and NSAID are scheduled drugs and doctors know when not to use them. Antibiotics are among the most valuable molecules in medicine today because of their ability to destroy micro-organisms like bacteria. However, this does not mean that antibiotics are a cure-all. Antibiotics are not used to treat all infections, because these can be caused by viruses, parasites, and other micro-organisms on which they have no effect. Infections like cold, chicken pox, herpes are all caused by viruses. Some illnesses, such as ear infections and diarrhoea, may be either bacterial or viral. Since all bacteria do not respond to the same antibiotic, the infectious agent must be identified before the best treatment can be initiated. This is done by doing a culture test, in which case the results will be available only after two or three days. Until then no antibiotic is prescribed. If an antibiotic is used then it will interfere with the culture growth. Apart from these there are side-effects such as diarrhoea, rashes, acute allergic reactions. Some may even damage the kidney, the auditory nerve or bone marrow. Another important aspect of indiscriminate use of antibiotics is the emergence of antibiotic resistant strains of bacteria. The best example would be the anthrax scare in the U.S. when many people coerced their doctors and took prescriptions for ciprofloxacin. Now several resistant strains of bacteria seem to have developed in the U.S.
In my practice, I try to educate patients about side-effects and development of resistance by misusing various drugs. Some of them comprehend the seriousness of the mistake while the rest of them scoff at it. To some I narrate an analogy between a cheque leaf and a doctor's prescription. When so much importance and security is given to draw one's own money from a bank, why not show similar care for one's health?
In this regard. I have two episodes to quote. A patient was not dispensed drugs when my prescription was presented at a medical shop near his residence. The reason was that the date on the prescription was more than three months old, hence he advised the patient to have a review with the doctor. The second episode is from a city medical shop that did not even bother to look at the date of the prescription, which was more than a year old. The reason given by the pharmacist was if he did not honour the prescription, the medical shop next door would do it, and he would lose his business. Thus it is imperative that we condemn the practice of self-medication.
Medicine is an ever-changing field. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in drug therapy become necessary or appropriate. This being the dictum of the day, to use drugs indiscriminately by way of self-medication should be condemned.
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