to untangle. Australian television networks are currently featuring male sportsmen to advertise an Australian brand of dietary supplements. These advertisements suggest men who play sport need more vitamins to be a success, like the man in the ad. As men currently take MVMs less frequently than women then pushing vitamins to this group would lead to a growth in sales.
MVMs only represent one section of dietary supplements. In 2007 the US expenditure on non-vitamin, non-mineral and so-called ‘natural’ products, such as fish oil, glucosamine, and echinacea was $14.8 billion. That is one-third of the sum Americans spend on prescription drugs. Over-the-counter medicines are a fast growth industry[ii] and research shows that current industry profit is expected to grow from $3.5 billion to $4.6 billion in 2017-2018. Other countries are experiencing a similar growth in self-medication. For example, in Australia, Canada, and the United Kingdom annual expenditure on herbal medicine is estimated to be US$80 million, US$1 billion, and US$2.3 billion respectively.[iii]
One Australian study found that more than eighty per cent of its participants took one or more OTC medicines daily, and of those two-fifths had taken five or more in the previous twenty-four hours. Prescription drugs are also part of many people’s daily routine, a survey in the UK found 43% of men and 50% of women had taken such a drug in the previous week and some had taken three.[iv] Interestingly, most participants used both dietary supplements and conventional remedies. The most commonly used medicines were antihypertensive agents, natural marine and animal products including fish oil and glucosamine, and lipid-lowering agents (for cholesterol control). The items on this list represent a growing tendency for packaged drugs (as well as those ordered by prescription) to aim at curtailing health risk factors; that is, disease prevention.
In Germany the story is slightly different since about 20% of herbal medicine is sold only on a prescription-basis and about 80% is sold over the counter. Regardless of how they are obtained the rate of herbal medicine use is on the increase. Between 1970 and 2010 the overall number of Germans using herbal medicine increased to well over two-thirds of the population. All expenditure on herbal remedies amounts to approximately one billion euros. Given there are other retail outlets such as drugstores and the internet, the usage is probably considerably higher. The propensity to pop pills seems endless in many countries, so why has this trend occurred?
There are several reasons for self-medicating. Since we are no longer the passive consumers of health we once were, many of us want to take charge of our own health and what happens to our body. Self-diagnosing and medicating engenders a feeling of control. But how many of us take the time to thoroughly investigate whether the OTC remedies actually relieve symptoms and/or promote health? The answer is probably very few. Yet it is an indisputable fact that consumers in the USA, UK, Europe and Australia do not take herbal remedies and vitamins simply as dietary supplements, although this is how they are officially classified. Nearly a quarter of Australian adults use complementary and alternative medicine in the treatment of chronic illness according to a National Health Survey database. In this group the complementary medicines were used for arthritis and osteoporosis but fewer than 10 per cent used non-prescription medicines for asthma, diabetes or heart and circulatory conditions. As might be expected these users tended to be older females with lower education levels and income,[v] and that is unlike Australian OTC users in general, who tend to have higher education and incomes levels as noted below.
Quite obviously many people expect OTC medicines to have a therapeutic effect. When taking echinacea for colds or flu it is expected to have some effect on the body, just as a prescription for an antibiotic for pneumonia is expected to work. When an analgesic such as Panadol is taken for arthritis pain, relief is the expected outcome and the same applies for non-steroidal anti-inflammatory drugs (NSAIDs). In terms of effectiveness the reason for taking these OTC remedies is much the same as the reason for taking prescription drugs and they are used in similar ways.
Another reason why self-medication is so widely used is that remedies for mild complaints are extensively advertised and are readily available. Since a visit to a practitioner is not required, popping a pill saves time and money. No doubt changing attitudes to conventional health care, and increased knowledge of health matters, also play a part. Trust in orthodox medicine has declined over the last thirty years. Press reports of medical negligence and malpractice, as well as the overuse of antibiotics, and their effects on the environment, suggest that orthodox medicine is less trustworthy than previously believed. Yet quite a few people happily trust long-used, traditional ‘natural’ remedies but as we will later discover such trust is not always justified.
Surveys have found that our reasons for buying pre-packaged medicines fall into two broad categories. The first is health maintenance or improvement: for extra energy or stamina, improved memory or mental agility, prevention or treatment of common illnesses like colds and flu or more serious illnesses, to slow down the aging process or to improve sexual function. It is difficult to be certain if any of those conditions are improved by OTC remedies, therefore it is not surprising that health maintenance and improvement is a mainstays of the diet supplement industry which thrives more on hope than effective performance. Since laws are in place to prevent claims of efficacy appearing on OTC labels, the characteristics of the people who are its greatest supporters do seem surprising. Australian and American surveys suggest that those who use OTC remedies are mostly females between the ages of 15 and 50. By comparison to non-users, they are more likely to be well-educated, have a higher economic status and a higher household income. So, it is mainly middle-class women who are filling the coffers of mineral and vitamin supplement manufacturers. Since these people are likely to be savvy consumers, they know that the biggest killers are cancer, heart conditions and strokes. Hence, they are concerned to maintain their health status by exercising, dieting and supplementing their diets with minerals and vitamins. Everyone wants to remain healthy, so instead of swallowing tonics as they did in previous centuries, they pop a pill and go to the gym.
Laudable as the pursuit of health maintenance is, high consumption of these items may not be necessary. The irony is that people living in western countries with a high living standard have ready access to balanced diets which provide the essential nutrients. The recommended dietary allowance (RDA) for minerals and vitamins has been set in the United States at a level which should meet the needs of ninety-seven to ninety-eight per cent of averagely healthy individuals. This level is aimed at decreasing the risk of chronic disease as well as normal health maintenance. Of course, there are groups of people who do need to supplement their diet with added vitamins and minerals. Patients recovering from major surgery or debilitating illnesses may benefit from added vitamins and minerals. Anyone who, for some reason, is unable to eat a balanced diet for a prolonged period is advised to use supplements. Artificially-fed infants and pregnant women usually require vitamin supplements. Those who are on a vegan diet may need supplements but vegetarians who eat a varied diet probably do not. Clearly different individuals have different requirements depending on their health status or age, but the perception that all and sundry require supplements is an artefact of advertising.
Another reason for self-medication is the treatment or reduction of symptoms such as anxiety, stress or depression, or to help women’s menopausal symptoms, or to treat or relieve symptoms such as the pain associated with some illnesses.[vi] Medicines to relieve allergies such as hay fever are also widely used. Some non-prescription drugs containing antihistamines can provide temporary relief but may cause drowsiness in susceptible people, so sometimes pseudoephedrine, which helps nose blockage and chest wheezing, is sometimes also added to counteract any sedative effect.
Other non-prescription medicines in wide use are pain-relievers such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). Aspirin (a derivative of the bark of the willow tree) has been known as a painkiller and antipyretic with an anti-inflammatory effect since 1763, along with other trees and plants contain salicylates, such as wintergreen, black cohosh root, poplar tree bark and sweet birch bark.[vii] Then in 1950 an English family doctor observed its anti-clotting properties and published several papers on the subject. Twenty years passed before his observation was taken up by a biochemist, John Vane, who won a Nobel Prize in 1982 for showing how aspirin discouraged
