Homeopathy and self-medication in the EU: past - present - future
Robert Jütte is Director of the Institute for the History of Medicine of the Robert Bosch Foundation and Adjunct Professor of History at the University of Stuttgart. He is a social and medical historian and the author or editor of over 35 books, among them a history of complementary and alternative medicine. He is member of the steering committee of the Scientific Board of the German Medical Association.
Half of all medicines sold in the EU have a non-prescription status. This developing market in the EU was estimated in 2011 to be close to 27 billion Euro, or approximately 15% of the total pharmaceutical market. There is a great diversity not only in the number and type of medicines that are available without prescription across the EU, but also in the self-medication market. According to a survey based on primary data collected by the Association of the European Self-Medication Industry (AESGP, 2012) the sales value of self-medication products as a percentage of the total pharmaceutical market ranges between 5.2% (Norway) and 26.7% (Switzerland). The EU market for homeopathic and anthroposophic medicinal products is valued at over €1 billion a year (ex-factory sales). These are impressive figures, and yet there seems to be even more potential.
There can be no doubt that the healthcare system is changing across the EU. With an ageing population and increasing economic constraints, policy makers try to find out how to make best use of healthcare resources. One obvious solution is to encourage people to take more responsibility for their own health and wellbeing. At the same time, patient behaviour is also changing across Europe, particularly with regard to growing empowerment in self-care, new routes of access to medicines, and cross-border patient movement.
Self-medication has been an important part of self-care for a long time, as it enables people to treat or prevent short-term or chronic illnesses once they decide not to consult a physician. A recent historical study has shown that homeopathy was used for self-medication from the very start. Already in the nineteenth century, both the theory and practice of homeopathy were considered easy to learn and to understand. The patient who by nature is familiar with his bodily symptoms needs to know only the easy-to-grasp law of similars. This basic principle of homeopathy guides him through the materia medica. Popular guidebooks for lay people which were available in Europe already in the early 1820s empowered the patient and helped him to ensure the “correct” application of homeopathic remedies in the case of self-treatment. Homeopathic doctors were also the first to set standards. They made lay people realize that there were limits to self-medication, and that in the case of serious illness, the advice of a professional health-care provider was essential. Thus homeopathic doctors played a key role in supporting their patients in self-care and in ensuring informed use and proper choice of non-prescription medicines by the patient. Homeopathy is the best proof for health policy-makers that a therapy which for more than two hundred years has enabled people to manage health conditions can have exemplary effects of patient empowerment and self-management.
The World Health Organization defines self-medication as “the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms”. Self-medication includes the use of non-prescription drugs and a range of different alternative medicines such as herbal remedies, food supplements, and traditional products. In many illness episodes, self-medication is the first option. It is a common practice, not only in developing countries, but also in industrialized nations that have a well-functioning health care system. People prefer self-medication for coughs and colds, for pain relief, gastro-intestinal complaints and skin diseases. The reasons for self-diagnosis and self-medication often quoted by patients are the uncomplicated nature of the illness, emergency use and prior experience with non-prescription drugs. For India we have research data, though unfortunately not for Europe, showing how self-medication and the use of complementary medicine might differ. In a recent multi-centre study which included 3588 patients, one can find data on the prevalence, the consequences and causes of self-medication. 12% of the participants admitted to self-medication, but only a small minority was on regular self-medication. Among the various therapies suited for self-medication, conventional medicine was by far the most popular one. Homeopathic medicines without prescription were taken by roughly 11%. Ayurveda, interestingly enough, was less popular in this sample of Indian patients in West Bengal. Another important finding of this study is that more than half the patients who resorted to any kind of self-medication had an adequate knowledge of the medicine taken and of the dose regime. According to a statement by the World Medical Association “Responsible self-medication […] is the use of a registered or monographed medicine legally available without a physician's prescription, either on an individual's own initiative or following advice of a healthcare professional.” Other requirements stated in this document suggest that individuals choosing self-medication should be able “to recognize the symptoms they are treating; to determine that their condition is suitable for self-medication; to choose an appropriate self-medication product; to follow the directions for use of the product as provided in the product labelling.” It seems that even in developing or newly industrializing countries such as India, people who choose to self-medicate are to a large extent able to recognise when their condition may be the sign of a more serious disease, indicating that a professional diagnosis and medical treatment are needed.
Nevertheless, further efforts have to be made – not only in India but also in Europe – to ensure that access to non-prescription medicines does not lead to inappropriate self-medication and that non-prescription medicines (including homeopathy) are used appropriately so that patients do not delay in seeking a doctor’s advice if they have a serious illness. The history of homeopathy provides ample evidence of how this goal can be achieved. It indicates that self-medication has the potential to play an increasingly greater role in public health.