Last winter, Javier G., a 58-year-old office worker in Mexico City, came down with what he believed to be severe flu symptoms.
His sore throat, fever and pounding headache sent him running to his nearest pharmacy to pick up a box of Bactrim, a popular sulfonamide antibiotic.
Within half an hour after taking the medication, Javier went into severe anaphylactic shock and had to be rushed to the hospital for emergency treatment.
Javier's doctor later explained that the interaction of the Bactrim with his body's own antibodies resulted in bronchoconstriction, along with hypertension and cardiovascular collapse. This could easily have killed him.
Because Javier received timely treatment at the Hospital General de Mexico, he recovered from the incident, but not all patients who self-medicate are quite so lucky.
In fact, according to the Health Secretariat, anaphylaxis accounts for approximately 300 deaths in Mexico each year, and a large percentage of those cases are the direct result of patients self-administering medications without a doctor's supervision.
"The problem in Mexico is that many patients take drugs that are supposed to require medical prescriptions without bothering to consult their physicians," Veronika Wirtz, head of pharmaceutical research at the National Institute of Public Health, or INSP, told The News. "And unfortunately, since there is no strict enforcement of the laws requiring that patients present medical prescriptions to purchase these drugs, there is a laissez-faire attitude about this practice."
Wirtz went on to say that last year the INSP conducted a survey of patients purchasing pharmaceuticals and discovered that about 61 percent self-medicate.
The National Association of Mexican Physicians, or Ananem, puts that estimate even higher, stating that about 80 percent of the nation's population regularly self-medicates.
Centro Medico Nacional's Cesar Erosa Gonzalez added that the two most commonly self-prescribed drugs in Mexico are penicillin and Erythromycin, two powerful antibiotics with potentially fatal side effects.
"In order to understand the problem in Mexico, we must first recognize that there is a difference between self-medication and self-prescription," Wirtz said. Medications such as aspirin and antacids are over-the-counter, or OTC, and most people can use them for mild, common ailments.
About 20 to 30 percent of the roughly 7,000 medications currently sold in Mexico fall into the OTC category, Wirtz said, while antibiotics and stronger medications require a doctor's prescription to be sold.
"There are very good reasons that these medications are not OTC," Wirtz said.
"Some of them can cause very severe reactions or may be counter-indicated in patients with specific health conditions or who are taking other medications."
By the same token, Wirtz said that many of these drugs require medical follow-up, meaning that a doctor will want to monitor how effectively they are working.
ENFORCEMENT LAX
Wirtz pointed out that many patients who self-administer non-OTC drugs end up taking the wrong medication.
"A lot of people in Mexico will take an antibiotic when they have a cold," she said.
"But since most of the time their symptoms are caused by a virus, not a bacterium, the antibiotics do them no good at all, and may even cause a negative reaction."
Even worse, she said, the overuse of antibiotics can lead to the drugs losing their effectiveness, thus potentially depleting the medical world's arsenal of weapons against the spread of diseases.
"As long as the laws are lax, people will continue to self- prescribe, and that means serious risks to the general public."
She also stressed that it is the responsibility of the government, and not the consumer, to regulate sales.
The Pan American Health Organization, or PAHO, agrees.
In a report it issued recently in Washington, D.C., the PAHO stated that "it is unreasonable to try to place responsibility for the illegal access of prescription drugs on the consumer or patient."
The PAHO report went on to say that the availability of such drugs without prescriptions "clearly shows a lack of professionalism within the commercial sector and the blatant infraction of legal dispositions on the part of the responsible parties."
MEXICO'S PLM IS NO PDR
Another problem complicating the pharmaceutical landscape in Mexico, Wirtz said, is the absence of adequate printed information about the medications being sold.
"In the case of OTC drugs, there are usually some indications as to usage, either on the box or inside the package," she said.
"But in the case of prescription drugs, the only information usually provided is on the outside of the package, saying that the patient should follow the indications of their physician."
Obviously, if the person buying the medication has not consulted a physician, chances are they have no idea how and when to use the drug.
Even more disturbing, Wirtz said, is the fact that many people will ask the salesperson at the pharmacy to suggest a medication or recommend how to use it.
"Pharmacies in Mexico need only have a trained pharmacist on hand two hours a week," she said.
"So chances are that the person giving them advice is not a trained professional."
And unlike in the United States, where doctors and pharmacists have access to a standard Physicians' Desk Reference, or PDR, which is produced in cooperation with the U.S. Food and Drug Administration, Wirtz said that there is no unbiased resource of updated information available in Mexico.
"Most pharmacies and doctors have a copy of the Guia de Especialidades Farmaceuticos, or PLM, but unlike the PDR, this is basically a yellow-pages directory with information provided by and paid for by the pharmaceutical companies themselves," Wirtz said.
"Not all medications are in the book and the pharmaceutical companies have a vested interest in promoting their products, rather than giving a balanced account of their pros and cons."
Wirtz said that although there are no reliable statistics as to what percent of available medications are listed in the PLM, she suspected that perhaps 20 to 25 percent of drugs sold in Mexico are not included.
"What we really need is for the Federal Commission for the Protection Against Sanitary Risks, or Cofepris, to oversee the production of a book like the PDR," Wirtz said.
"We also need to launch a national campaign telling people not to self-prescribe medications and we need the government to begin enforcing the existing laws." To see more of The News or to subscribe to the newspaper, go to http://www.thenews.com.mx/. Copyright (c) 2009, The News, Mexico City Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2009, The News, Mexico City