new internationalist
issue 165 - November 1986

Why we pop pills
Exotic medicines like tonics, pick-me-ups, vitamins
have never been more popular. The huckster with his bottles
of coloured water persists in the twentieth century. Our search
for perfect health is analysed by Judy Gahagan.

What kind of cough is it?' asks the pharmacist. Whatever reply is mumbled, the solution is likely to be one of the mass-market cough mixtures. Most of these work like one-man conjuring shows, simultaneously suppressing and stimulating the cough, and drying up and liquefying mucus. Some of them, for good measure, can upset the stomach as well. The UK Joint Formulary Committee (the national pharmaceutical body which lists all available drugs) consider there is no scientific basis for using medicines of this sort, and that their use is to be deprecated.

'Have you packed the Diarrest'? a million couples shriek to each other as they pack for the overseas vacation. Diarrhoea, or the threat of it, leads people to stock up on preparations which are supposed to cure it, prevent it, or both. However the preparations commonly available for holidays are considered by reputable medical opinion as useless for common diarrhoea. There is no evidence that Diarrest, for example, prevents it. There is some evidence that preparations like Enteromide can prolong it. And considerable evidence that Lomotil, though it may be convenient for adults, is dangerous to children.

Although the power of medical science over the body has assumed God-like dimensions with its wonder drugs and replacement surgery, anxiety and suspicion of the body's health are more widespread today than when medicine was far less advanced. Rather than viewing the body as a remarkably tough system, designed to survive extreme conditions, we see it as a fragile mechanism whose equilibrium will be disturbed without constant vigilance and protection. And central to this protection, we believe, is the use of medication.

Because of this we consume large quantities of medicines for common minor illnesses, like coughs, colds, diarrhoea, indigestion, fleeting pains and pure floppiness, even though these conditions will subside without any intervention at all. And we take vitamins and mineral supplements as prophylactics against the risk of minor illnesses. Most of these substances are, at best, unnecessary and at worst, likely to prolong the condition and have dangerous side-effects. There are the antacids like Bisodol which can upset the body chemistry but not the acid; the nasal sprays which used for more than a few days make the condition worse; the throat lozenges, like Tyrozets, which are sold in Britain yet banned in parts of the US because of doubts about their safety.

Even when everything is ticking over all right in the body, people mess about with vitamins and tonics. A 1984 survey carried out by WHICH?, the three-quarters of a million circulation British consumers magazine, showed that one in five of their sample cross-section of the public were buying vitamin preparations simply to protect themselves against the possibility of minor illnesses. This study indicated that, except in unusual circumstances of strange diets or lifestyles, the taking of extra vitamins had absolutely no justification or benefit at all. Ordinary cheap food contains adequate supplies of vitamins and other essentials for the body. For example, one orange contains 75 per cent of the most extravagant estimate of our daily requirements of vitamin C. Widely publicized claims for the prophylactic benefits of extra vitamin C are, as yet, unsubstantiated.

The use of vitamins as dietary supplements is only valid in those parts of the world where people can't afford a proper diet, let alone a supplement, and accordingly suffer from serious vitamin-deficiency diseases. Yet if they cannot afford cheap food, what is the logic of feeding them with far more expensive vitamin pills?

The thinking behind this irrational use of vitamins is that if something is good for you, then even more of it is better - and this is played on with the promotion of vitamin products.

Vitamin supplements are not usually sold in pure form - they would then be too cheap - but in preparations involving several vitamins and in tonics with iron supplements. Some of these mixtures are self-defeating because they involve conflicting methods of administration. For example, supplements of iron, which needs to be taken orally, are put together with vitamin Bl2, of which so little is absorbed orally that vast doses are needed. As with vitamins, the case for taking extra iron is non-existent, except in a tiny proportion of cases.

Why do people waste their money on this socially legitimized form of drug abuse? One reason is that the suspicions people have about their bodies are fanned by those who produce the medicines. Health consciousness and health anxiety are the necessary conditions for a receptive market. Much promotion works indirectly by focusing people's attention on health. Promoted in a pseudo-scientific manner, it enjoys high credibility with the public.

For example, Booker Health Products produced a glossy report called The Booker Health Report, circulated by their public relations consultants late last year. This health-food company's sponsored publication reached the unsurprising conclusion that most people require supplements of vitamins and minerals. The academic guise of the findings led one journalist to believe that it was independently sponsored research, and The Guardian devoted a full page story to 'the findings'. In fact there is only the faintest resemblance to a scientific paper. The sample of 800 people is minimal, and virtually no details are provided about the data on which the conclusion was based.

Similarly booklets are available in supermarkets and health food shops which simply contain 'information' about the body's functioning and, say, the role of vitamins. Most women's magazines contain articles discussing health problems. Implicit in this type of material is the idea that medication has a key role in health.

In a world dominated by science, people have come to expect the physical world to be predictable, controllable and perfectible. The many mysteries of health and sickness are simply not acceptable to the modern psyche. In order to enjoy the illusion of control over these mysteries we keep little home alchemy sets in the bathroom.

Enjoying excellent health compared to the Third World poor, we nevertheless expect to enjoy perfect health. We cannot accept that excellent health still means that, from time-to-time, we may be a little bit ill, and natural fluctuations in the body's state will involve minor discomforts. The search for perfection is a major resource for promotion. We are prepared to spend small fortunes on rooting out personal imperfections like fatness, baldness, mis-shapenness, old age and above all, departures from perfect health. The perfect body is the modern equivalent to a state of grace, and inert or irrelevant substances are the equivalents of rosaries or worry beads.

To complicate matters useless preparations can appear to work. Since many minor illnesses are self-limiting, the inevitable recovery after taking a medicine will be attributed to its curative powers. We have a strong tendency to believe there is a causal relationship between the two adjacent events. This belief is considerably strengthened by advertisements and promotional leaflets in some doctors clinics. Doctors, also conditioned by pharmaceutical companies to believe in the importance of medication and to prescribe accordingly, give scientific credibility to our belief. And when we buy from over the counter in the drug store the blurb on the bottle's label will strengthen our belief that this medicine cures.

However there is the placebo effect, that is, believing in the power of medicine does somehow influence the body's recovery. Placebo means 'I please', and the power of inert substances has been pleasing patients and producers alike for centuries.

While pharmaceutical companies do produce essential drugs and research the treatment of hitherto untreatable illnesses, most of their activities concern the development of new versions of already unnecessary preparations in order to compete with their rivals. Medicines for minor illnesses and vitamin preparations rank in the top four products on which advertising expenditure is lavished. The profits are spectacular. Bookers (formerly Booker McConnell) reported that in spite of price increases of 65 per cent the sales of 'vitamins increased by 165 per cent to 1982. Although by 1984 the rate of increase of sales of vitamins had slowed down, nevertheless their vitamin producing subsidiary, Leiner, reported an increase in profits of 39 per cent that year.

The removal of branded, unnecessary medicines from the UK National Health Service prescription list (achieved at the 11th attempt) is estimated to be saving the NHS around £75 million ($112 million) a year in a total drugs bill of nearly £2,000 million ($3,000 million). However it's an ill wind that does nobody any good. The industry, still sore about its unsuccessful fight against last year's drug legislation, is anticipating a loosening of regulations affecting over-the-counter medicines which would bring fresh promotional opportunities in the UK. They have launched an 'ask your pharmacist' campaign. Pharmacists benefit directly from the sale of medicines in a way that family doctors don't. And they anticipate that if people can't get their fix from a scribbled prescription then the pharmacist will be delighted to supply them.

Judy Gahagan has been a lecturer in Psychology at the North-East London Polytechnic and is now a freelance writer in sociology and politics.

If it's printed it seems true. But you might be having the wool pulled over your eyes. Each month the NI invites one author to justify their style of argument. Editor: Your choice of words disparages those who see their bodies as 'fragile', needing 'vigilance' and 'protection'. Doesn't this technique marginalize some and shift the reader's sympathy onto your side without them consciously having to be convinced by a well-argued case. Gahagan: I believe the human body can withstand varied and often extreme conditions and that confidence in the capacity reduces anxiety and therefore enhances health. My choice of words reflects my stance. It is pure myth to imagine that an article can have a neutral tone. The very selection of an issue, let alone the choice of arguments and words, is the result of a stance or bias.   Editor: You use a survey by the consumers magazine, Which? To show 20 per cent of those taking vitamins had no justifications. Yet elsewhere you dismiss a survey by Bookers showing vitamins were necessary. Isn't this using the survey technique when it suits you, while dismissing it when you disagree with the findings. Gahagan: To determine the credibility of research, or a survey, you first look at the motives of those who implement it. Bookers sell and profit form vitamin and mineral supplements and their largely positive findings must have been seen in this light. Which? however is an independent consumer periodical which evaluates thousands of different products, and whose income depends on the sale of their journal which reports those findings. Nobody would buy Which? if they thought it had financial interests in the products they investigate.   Editor: You make sweeping medical statements as if they were self-evident truths; 'the case for taking extra iron is non-existent', why should we believe you? Gahagan: You shouldn't. Not without questioning my sources. In this case the major source was the Social Audit publication The Wrong Kind of Medicine by Charles Medawar. My confidence in his conclusions was based on their reference to research published to the standards demanded by scientific journals.