Medicine

If they sell it over the counter it must be okay, right? Not necessarily

SHEILA GORMELY November 1 1976
Medicine

If they sell it over the counter it must be okay, right? Not necessarily

SHEILA GORMELY November 1 1976

If they sell it over the counter it must be okay, right? Not necessarily

Medicine

Their chemical names—glyceryl guaiacolate and chlorpheniramine—are often unpronounceable. But that plethora of potions and elixirs, stimulants and sedatives, antacids and analgesics that line the shelves of most Canadian drugstores represent a four-billion-dollar a year industry in North America, and a habit most Canadians steadfastly refuse to shake. Bombarded by $400-million advertising campaigns that promise fast relief for coughs, colds and sore throats (one U.S. firm alone, Bristol Myers, spends $150 million a year promoting its products), few consumers stop to question the safety and efficacy of over-the-counter drugs.

Last month, the U.S. Food and Drug Authority (FDA) released a 900-page report that seriously challenges the worth of the entire $700-million cough and cold remedy market. Says Dr. Sol Katz, director of the pulmonary disease unit at Georgetown University: “But for Aspirin and a few other exceptions, I would ban almost every cough and cold product sold today.”

In Canada, as in the United States, prescription drugs are subject to rigid government standards of safety and effectiveness. But over-the-counter (OTC) medicines are not government tested. “No one has tested Contac-C against Aspirin,” notes Toronto clinical pharmacologist Dr. Ed Sellers. “Why would a company want to show that its expensive product is as effective as chicken soup?”

At best, most experts conclude, OTC drugs—taken moderately and not in combination with other medication—are either useless or only slightly effective. At worst, they may cause grave problems for patients with existing ailments (see box). But the most worrisome danger zone—and the most uncharted—is that created by the interaction of over-the-counter remedies with alcohol and/or other prescription drugs. “Even if you know the safety and effectiveness of each component, it’s impossible to know what they will do in combination with other drugs,” notes University of Calgary pharmacology professor Dr. Keith MacCannell.“It’s a very dicey area.”

Apart from the risks of multiple drug use, many physicians bemoan the vast waste of consumer dollars. “The public has not been told strongly enough that these medicines aren’t worth it,” says the Ontario Medical Association’s director of medical services, Dr. E. J. Moran. “The large bulk are garbage, and the few that are effective carry some hazard.”

The FDA study, the culmination of a four-year investigation involving 119 re-

searchers, verifies those assumptions. “There appears to be little evidence that antihistamines have any effect on the common cold . . . There is not one sleep aid whose ingredients we consider effective ... There are no well-controlled studies documenting that ‘expectorants’ [cough medicines] work.”

Adds Sellers, head of clinical pharmacology at Ontario’s Addiction Research Foundation: “There are four over-thecounter, proprietary and patent medicines that are any good. Forget the rest.” His list of effective drugs : asa—the most common brand name is Aspirin (“probably the only medication most people need for a cold”); nasal sprays (“for a short period since they can irritate nasal membranes”); antacids for stomach upsets and heartburn (“many stomach problems have nothing to do with excess acidity and antacids won’t help”); and laxatives (“how many people really need a laxative?”).

But if over-the-counter remedies are plainly ineffective, why do millions of North Americans reach for “tiny time capsules” at the first sign of sore throat and cold? The answer lies both in the industry’s . lassive ad campaigns (most drug firms

spend between 15 and 30 cents of each sales dollar on advertising, compared with seven cents for large food companies) and the placebo phenomenon, which bears witness to the fact that some patients get better just by being told a certain pill will make them better. “A cold is going to run its course anyway,” admits Dr. R. D. Peterson, director of research and development for Kellogg Salada Canada Ltd., makers of the best-selling Neo Citran cold and allergy preparations. “But the psychological effect is very important.”

While the Food and Drug Authority continues to treat the drug companies with unaccountable leniency, Ottawa’s Health Protection Branch is making some effort to rid the marketplace of patently fraudulent medicines. Legislation planned for the spring will wipe out the Proprietary or Patent Medicine Act and require disclosure of ingredients. Predicts Dr. A. J. Liston, director general of the FIPB’S drugs directorate: “The new regulations will eliminate two thirds of the proprietary and patent medicines now in existence.” But whether the listing of ingredients will change the habits of drug hungry Canadians remains to be seen. SHEILA GORMELY