Life can be quite uncertain, but there are two things we can be sure of: we will pay taxes and we will get sick at some point. Even though doctors are highly respected in Belgium, only about 1 in 3 people go to a doctor when they have a (minor) illness. Instead, 2/3 of patients try to treat themselves. They treat themselves with over-the-counter medicines, natural remedies, ointments or whatever they think works for them.
There is nothing wrong with this practice in theory; respect for patient autonomy is one of the four principles of medical ethics after all.
Autonomy is an important concept in western thought. The foundations were laid by the philosopher John Stuart Mill, who argued that autonomy is based on the individuality of each person, emphasising their unique perspective in determining the right decision.
While in philosophy this principle of Autonomy is already an old concept, it is still relatively new in the medical practice. Before the eighties, there was a “doctor knows best” philosophy, where a man in a white coat would decide what you should take and what medical treatments would be best for you. The digital revolution has put all the knowledge of the world in our hands, and together with the increasing level of education in our society, we see patients taking control and ownership over their own health. They often have non-medical arguments to delay or to speed up certain treatments. These developments have led to an increase in self-medication.
Given the certainty that people will self-medicate, governments can design and create regulatory frameworks to ensure that we reap the benefits of the self-medication, while limiting the negatives. The benefits are many; it is less of a burden on the economy since workers recover more quickly and take fewer sick days; It puts less burden on the healthcare system and the budget.
The negatives largely focus on the use of the wrong medication or the wrong dosage. In 2018, Sciensano stated that Belgium is not doing well in terms of the correct and rational use and prescription of Rx medicines. On the other hand, we also see that the market for OTC medicines has changed drastically in recent years. “Health supermarkets” are popping up on the streets and online pharmacies are growing and professionalising at an astonishing rate, bringing together many qualified pharmacists, using economies of scale.
This has led a group of Belgian lawmakers from the current governing parties to draft a resolution containing several good practices to regulate and encourage the safe(!) practice of self-medication. The lawmakers want to promote the initiatives of farmainfo.be, which provides citizens with correct information on OTC medicines. They also advocate the inclusion of OTC medicines in the Farmaflux platform “Gedeeld Farmaceutisch Dossier”, so that all pharmacists know what medicines you have bought and are using, regardless of where you bought them. This would give prescribers a more accurate picture of your medication regime and ensure that you are not taking medicines that may conflict with each other. Patients often use a combination of online and officina “in person” pharmacies, so online pharmacies could also be included in the “Gedeeld Farmaceutisch Dossier” to increase efficacy.
Another aspect of the resolution is for the government to work together with the FAGG and the pharmaceutical industry to reevaluate the sizes of medicine packages. In Belgium, we are good at starting a treatment plan with Rx drugs, but not at finishing it or phasing it out according to the resolution. Finally, the resolution reminds the regions to use their competences in preventive health policy to further raise awareness of responsible self-medication through information campaigns.
The Belgian health system and the level of care provided are of excellent quality, and by involving citizens as responsible and autonomous actors in this healthcare landscape, everyone can benefit; may this resolution be the start of a new policy journey towards better health for all.
If you want to discuss innovations in health policy, we’re always up for a coffee!
Jonas Veys, Senior Consultant & Ward Wuyts, Consultant – Belgian Team
