If you cannot get rid of it, regulate it. About self-medication policy in Belgium

By May 14, 2024May 16th, 2024BE insight, Brussels Office

Life can be quite uncertain, but there are two things we can be sure of: we all pay taxes and we all get sick at some point. Despite the fact that doctors are highly respected in Belgium, only about 1 in 3 people go to a doctor when they have a minor illness. Instead, 2/3 of patients try to treat themselves. They treat themselves with over-the-counter medicines (OTC medicines), natural remedies, ointments or whatever treatment they think will work for them. There is nothing wrong with this practice in itself; respect for patient autonomy is one of the four principles of medical ethics after all.

Autonomy has deep roots in the Western philosophical tradition. The foundations were laid by the philosopher John Stuart Mill, who argued that autonomy is based on the individuality of each person, emphasising their unique perspective in determining the right decision. This freedom stops where it harms the freedom or well-being of others; it’s not about disregarding others.

This principle is quite new in medical practice, for a long time, say before the eighties, there was a “doctor knows best” philosophy, where only a man in a white coat could decide for you what you should take and what medical treatments would be best for you. With the digital revolution, which has put all the world’s knowledge in our hands, and the increasing level of education in our society, we see patients taking control and ownership of their health. They often have non-medical arguments to delay or to speed up certain treatments. These developments have led to an increase in self-medication.

Given the certainty that people will self-medicate, governments can design and create light regulatory frameworks to ensure that we reap all the benefits of the practice while limiting the negatives. The benefits are many: it is less of a burden on the economy, as workers recover more quickly and take fewer sick days; it is less of a burden on the health care system, as fewer medical professionals are needed. And finally it is less of a burden on the treasury, as fewer medical professionals need to be paid for consultations or other services.

The negatives largely focus on the use of the wrong medication or the wrong dosage. In 2018, Sciensano stated that Belgium is not doing great in terms of the correct and rational use and prescription of Rx medicines. On the other hand we also see that the market for OTC medicines has changed drastically in recent years. “Health supermarkets” are popping up on the streets and online pharmacies are growing and professionalising at an astonishing rate, bringing together many qualified pharmacists and using economies of scale.

This has led a group of Belgian lawmakers from the governing parties to draft a resolution containing several good practices to encourage the practice of self-medication. The lawmakers want to promote the initiatives of farmainfo.be, which provides citizens with correct information on OTC medicines. They also advocate the inclusion of OTC medicines in the Farmaflux platform “Gedeeld Farmaceutisch Dossier”, so that all pharmacists know what medicines you have bought and are using, regardless of where you bought them. This would give prescribers a more accurate picture of your medication regime and ensure that you are not taking medicines that may conflict with each other. Patients often use a combination of online and officina pharmacies, so online pharmacies could also be included in the “Gedeeld Farmaceutisch Dossier” to increase efficacy.

Another suggestion from towards the government is to closely monitor and possibly regulate the number of capsules in a pack of medicines to prevent overconsumption. In Belgium, we are good at starting a treatment plan with Rx drugs, but not at finishing it or phasing it out. Finally, the regions are invited to use their competences in preventive health policy to further raise awareness of responsible self-medication through information campaigns.

The Belgian health system and the level of care provided are of excellent quality and by involving citizens as responsible and autonomous actors in this healthcare landscape, everyone can benefit; may this resolution be the start of a new policy journey towards better health for all.

If you want to discuss innovations in health policy, we’re always up for a coffee!

Jonas Veys – Senior Consultant PI Brussels

Ward Wuyts – Consultant PI Brussels