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Medicine overuse is a bitter pill to swallow

According to the National Health Insurance Fund, Hungarians rank third in Europe when it comes to unnecessary medicine use, and while the market has similar notions, professionals emphasize that there is no clear-cut definition as to which medicines qualify as unnecessary or redundant. Cultural background is certainly a key factor of medicine consumption, but increasingly so is price.

“The key numbers in medicine sales in Hungary have been virtually unchanged over the last 15 years,” says Dr. Attila Horváth-Sziklai, professional secretary of the Hungarian Pharmacists’ Chamber (MGYK). “What might have changed, though, is people’s perception of what they consider to be a medicine,” he adds. With non-prescription drugs becoming more popular, the thin line between drugs and other, health-related products has grown more vague, meaning that people may now be less conscious about their medicine consumption than they were.

What is unnecessary or redundant is by no means clearly defined when it comes to medicines. Furthermore: the many players in the industry have entirely different definitions on the phenomenon. “For a pharmaceutical company, a medicine well-used equals a medicine sold. Pharmacists have three very different criteria,” says Horváth-Sziklai. “The drug needs to be necessary in a way that the person taking it will have to need some kind of medication. The medicine needs to be effective, meaning that the medicine the person takes has to have the desired effects on his health or symptoms, and finally it needs to be safe, in the sense that there are no side-effects, or if there are, they remain manageable,” he explains. From a professional point of view, if any of the above criteria are not met, the medicine is not being appropriately used, or, in other words, unnecessary.

“It is clear that Hungarians tend to buy more medicine than they actually consume, meaning that a significant chunk of the drug sold is wasted, but it is also true that most Hungarians take medicines for minor problems, such as a cold or a headache, and Hungarian doctors prescribe drugs more often than their colleagues in other European countries,” says a young pharmacist who runs a drugstore in Pest county in the vicinity of Budapest, but who asked to remain anonymous. According to her, the habit of medicine consumption is largely a question of cultural background and education, and neither extreme is optimal. “We can say that Hungarians use too much medication, but I have seen cases in other countries, where severe pneumonia occurred because the doctor prescribed anti-biotics way too late,” she claims. “It may sound awkward for a pharmacist, but I am not a pro-medicine person myself, meaning that things others deem necessary may slip into the redundant category in my view. But it is easy to see that the balance between factors promoting medicine use and those advising against it is nowhere to be found,” she adds.

Among the various factors that impact a potential customer in his decision on whether to use drugs or take alternative measures (for example drink two glasses of water for a headache or have a good night’s sleep for the beginning of a cold), marketing is a big one. It has become business as usual for the pharmaceutical industry to get top rankings in ad spending, especially as the competition gets more cutthroat with cheap, generic medicines entering the market in a growing number of areas. “It is immediately apparent in market demand, which medicine is advertised. TV is by far the strongest, but magazines also have a huge impact,” our source confirms.

Horváth-Sziklai adds that, “As for prescription-only medicines, the decision is ultimately in the hands of the doctors, and we have no valid grounds to question their competence.” So a prescription drug only becomes unnecessary in certain, rare cases, for example when the patient fails to cooperate with the doctor, and abandons the therapy, or if the boxes contain more pills than the therapy requires. “It may be a case of medicine overuse from the perspective of some other countries, but it doesn’t mean that these drugs are wasted. And we always have to remember that some 80% of the world’s drug production is used by 20% of the population. Normal use or overuse are, therefore, very relative terms,” the secretary adds.

The Health Ministry established a medicine-waste collection program in 2005, which may also be a good indicator for tendencies of unnecessary drug use. But industry experts say that there is not much to see there: following a peak shortly after its introduction, the number of returned drugs (unused or expired medicines) remains stable.

“There still exist a few who can afford impulse purchasing in pharmacies, but the price of non-subsidized, non-prescription drugs has increased hugely in the recent years, and most customers are highly price-sensitive,” says Horváth-Sziklai. “There is a valid need to have some medicine at home, but this pool needs to be filled only once. Other than that, I don’t think that people tend to spend too much on unnecessary drugs just for the sake of it,” he concludes.