Think - before using drugs! / Franck Nouchi

12 World Health • Morch-Aprill992 Think - before using drugs! Franck Nouchi Each year, the share represented by pharmaceuticals in health insurance payments rises by between 1 0% and 12%; this represents a doubling of the nation 5 health costs every seven years. T he French have always been passiona~ely devoted to medicine. The 17th century playwright Moliere, whose skill in taking the pulse of his compatriots had no equal, accurately described this phenomenon in Le medecin malgre lui (The doctor in spite of himself) and in Le malade imaginaire (The imaginary invalid). The people of France have a profound faith in the value of medicines and remedies of all kinds. Consequently they are world champions in the league table of consumers of tranquillizers and hypnotics; they each buy an average of 50 boxes of pills every year. This is one of those historical and cultural facts that seems to have no simple cause. After all, is life so poor in France that it justifies consumption of medicines that is twice that in Germany, or three times more than in the USA? Doctors and sociologists find it very hard to explain this bizarre behaviour, but this doesn't prevent them from issuing warnings to the French population about the health risks-and the inordinate financial cost--of this overuse. Last year, the government decided to launch a vast national campaign on the rational use of medicines, with the slogan "A drug is not something to be In France, a vast media campaign warns people against excessive drug-taking. taken lightly". The public authorities used the occasion to remind people that nearly half of all poisoning cases in France are due to medicinal drugs. In 1986 alone, 17 000 people went into hospital suffering from a drug overdose (and this figure does not include attempts at suicide). Moreover, children have a natural tendency to mimic the behaviour of their parents, and usually to an even greater degree. The consequences of this liking for medicines are truly serious. Each year, the share represented by pharmaceuticals in health insurance payments rises by between 10% and 12%; this represents a doubling ofthe nation's health costs every seven years. At this rate, the very survival of the social welfare system-up to now one of the best in the world-is put at risk. For some months, television "spots" have urged French people to use medicines more wisely, and to follow the prescriptions, dosages and duration of treatment recommended by their physicians. The impact of this campaign is going to be difficult to assess because of people's tendency to underestimate their own use of medicines. On the contrary, they convince themselves that they only World Health • March-Aprill992 Disseminating the message The central message of the French campaign "A drug is not something to be taken lightly" is being diffused through a variety of media , including direct information to all doctors and pharmacists, inserts in professional journals, and a 30-second televised spot, which warns viewers: "There are many drugs of many kinds, they are all made for looking otter your health . They all contain active substances to make the body react. They have to be taken in the right quantities, and there are combinations that must be avoided. Your doctor and your pharmacist know about drugs. Ask them for details and follow closely the treatment prescribed by your doctor. A drug is not something to be taken lightly. " Health professionals who wish to pass on the campaign message to their patients and clients will have a number of information materials at their disposal such as: • a small poster for pharmacies or the waiting rooms of hospitals or private practitioners, advising patients on the rational use of drugs and urging them to engage in dialogue with their doctor and pharmacist; ea leaflet containing general information on the use of drugs, available from doctors and pharmacies. Decentralizing the campaign is a key approach to bringing about far-reaching and lasting changes in each individual 's behaviour with drugs. The networks of the campaign organizers are being called upon to pass on and boost the message. Steering committees at regional levels are responsible for organizing and implementing information and awareness activities directed at local target groups such as health professionals, press clubs, companies, secondary schools and universities. Extracted from.· Essential Drugs Moni tor , 1 2: 20 ( 199 1) have recourse to drugs in cases of real illness, only 8% admitting to using medicines for the slightest illness! But the consumers of drugs are not the only ones to blame for this phenomenon. The prescribers, too, share some of the responsibility, since a "good" doctor in France is seen as one who prescribes plenty of medicines. In future, practitioners will have to learn--or releam-not to prescribe a drug automatically, at the least sign of a complaint. This will call for a true dialogue between doctor and patient, which in turn will inevitably entail spending rather more time on each consultation. Many doctors believe that this change of behaviour on their part, though desirable, is bound to result in raising the price for each consultation. But that's another story ... • M r Franck Nouchi is a medical iournalist with the newspaper Le Monde, 15 rue Falguiere, 7550 I Paris, France Let us not become slaves of the colourful little pills, but learn how to use them with moderation. 13