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In the age of digital society, nothing is more than two clicks away: we can organise our lives online and order basically everything to our home in the comfort of our armchair and a stable Wi-Fi. This is also the case for medication, and e-trade, which has been booming due to the pandemic, has acted as a catalyst for the sector. However, the quick and easy availability of products carries several sources of risk, not to mention if the intention to purchase is also fuelled by half-truth or false information racing at the speed of light. Why is it risky to treat a medicine at the same level with a phone case, what makes a medicine a medicine, and why can we suddenly think that an anthelmintic for animals is a panacea for COVID? We discussed these with Dr. András Fittler, Vice-Dean of the University of Pécs Faculty of Pharmacy.

Written by Viktor Harta

Internet access has now become as essential as the use of electricity, utilities or public transport. We can organise vacations online, buy bus tickets, manage our finances, and pack our virtual cart. According to statistics, there are fewer and fewer people who have never bought anything online and the range of products is growing in line with the law of supply and demand in economics. Online shopping has entered the pharmaceutical segment in recent years too, and e-trade, which was on the rise during the pandemic, has also revived online medicine sales. The demand side is high and there is no need to be concerned about supply: pharmaceutical ads are pouring out of TV, headaches go away from a pill, the other reduces daily stress, the next helps us sleep better, gain strength, or we can just ignore muscle strain.

"I saw it on the Internet, it must be good"

There are dozens of online pharmacies in Hungary as well, from where the desired product is delivered to people’s homes. But what is wrong with that? After all, online distribution of pharmaceuticals is fast, convenient, and epidemiologically safer than personal shopping. Ideally, there would not be any problems but in reality, it carries a number of risk factors.

"Medicine is a high-quality, tested product manufactured in accordance with a strict system of professional standards, the safe applicability, exact effect and expected benefits and potential risks of its use are known," said dr. András Fittler pharmacist, Vice-Dean of the University of Pécs Faculty of Pharmacy, associate professor who has been researching online distribution of pharmaceuticals for many years, dealing with the health and economic aspects of online pharmacies and counterfeit medicines, and the issue of conscious medicine use.

The medicine becomes whole with the useful set of information received from the prescribing doctor and the pharmacist who issues it, together with it, it actually becomes a medicine - emphasizes the associate professor. If we look at it as a mere product and we are not aware of how, for how long we should take it, whether we really need it, it will arrive without that set of information, it will lose its “medicineness”, it will be no more than a simple product, although it should not be seen that way.

“When we decide not to buy through the usual channels, such as not looking for the desired product in a store with the help of sellers, but on the Internet, it is not a disadvantage if we have the right knowledge and experience. You can buy shoes, a T-shirt, a laptop, a mobile phone with some online research beforehand as well. The worst thing that can happen is that it does not fit, the product does not work. In the field of medicines, however, we simply do not have the information to decide whether it is good for us, whether we need it at all and whether it provides help to our problem. We like to believe in panaceas; however, they have not been invented yet, but expertise and professional help are available. Advertisements do not do any good either: they take the special character of the medicine, put it on the same level as everyday products and people start looking at them that way, which is a mistake. It is important that we consciously buy medicine, ask for professional help, advice to get what we really need” - explained dr. András Fittler.

Pharmaceutical and patient safety - strict standards, not by accident

The medicine moves within a strictly controlled, closed supply chain, and its journey from pharmaceutical firms to pharmacies can be monitored until it is dispensed by the pharmacist with the appropriate information of its use. The essence of pharmaceutical safety is that the person who redeems the medicine always receives the product specified in the marketing authorization. Pharmaceutical safety is associated with patient safety, which means that the patient receives the right medication, in the right dose, at the right time, with the right advice on taking it. If we start taking medicine on an ad-hoc basis, after possibly self-diagnosing ourselves with arguable success, the “right medicine for the right patient principle” is lost.

“Self-medication, self-healing has always been present, but many people do not think about the harmful effects. We buy a tested, original product in vain if we do not need it, at best we will not achieve anything, however, at worst we will harm ourselves. In addition, we can have a false illusion, we delay going to the doctor and by the time we get there, the problem due to procrastination may be greater than if we had asked for help in time,” says the Vice-Dean.

The pandemic has given a boost to the illegal pharmaceutical market

The pharmaceutical market is huge, everyone is affected regardless of age and illegal players are trying to exploit this as well. There are several products that are restricted in access, i.e., prescription-only because they contain an active substance that can be prescribed by a doctor after consultation. There are consumers who, in search of “alternative” routes - for example because they do not want to go to the doctor or would prefer anonymity – end up at a dubious distributor who offers the prescription-only product without a prescription, even for many times the normal price. Based on current knowledge, there are tens of thousands of illegal distributors of pharmaceutical products in the world, but according to dr. András Fittler, their actual number may be higher than this.

The coronavirus epidemic has orientated many people to the online and presumably even illegal pharmaceutical market, partly due to uncertainty and partly due to a mixture of real and perceived information circulating very rapidly. The need for self-healing has further increased and the demand for certain product categories has also increased.

Many illegal players have responded to the increased demand, rising prices and public opinion. An excellent example of this is the sudden rise in interest in an active substance called ivermectin, which is mainly used in veterinary medicine as an anthelmintic, i.e., it has not been developed against coronavirus at all and its applicability to COVID-19 has not been proven. After news appeared in 2020 about whether this active substance could be used in case of coronavirus infection, the number of related Internet searches in Hungary increased.

Professional organisations have, of course, responded: the National Institute of Pharmacy and Nutrition (OGYÉI) stated in a statement that ivermectin does not have a therapeutic recommendation for the treatment of coronavirus infection, and the American Pharmacists Association warned on its website that the efficacy of the drug regarding COVID diseases simply cannot be evidenced.

Nevertheless, in December 2020, several Hungarian and English searches for ivermectin were found in Google's search history. If someone was looking for it in English, one could find quite a few illegal online distributors who offered the pills in various presentations and content of the active substances and in many cases also emphasized that they were available without prescription.

András Fittler pointed out that the above phenomenon is not unknown (e.g., in the case of various mystical food supplements, potency enhancers, consumer products, sedatives), but due to the pressure caused by COVID, these channels were established much faster, distributors followed the sudden increase in demand in response to misconceptions and news in the media.

The solution lies in the change of approach

According to the associate professor, distribution of pharmaceuticals on the Internet is not bad if it takes place through appropriate, traceable and controlled channels. It is bad if this activity is carried out by players who are not pharmacists, whose motivation is to make a profit, even at a price where their “work” poses a financial or health risk to others.

If someone buys a completely original, tested drug without medical consultation from a website that is not operated by a pharmacist, they are also at risk. Healthcare professionals are needed to make a product a medicine, after proper diagnosis and medicine information advice.

“The pharmacist is a guarantee of pharmaceutical and patient safety in the health value chain, he or she is there at the last minute before we get the product,” emphasized dr. András Fittler. He believes the solution lies in the change of approach: medicines should not be seen as pieces of clothing, as disposable items of use. It is no coincidence that their manufacturing and distribution are regulated and supervised, and they are issued by a pharmacist not by accident, we can ask him or her for advice before we start taking it. Instead of rumours, social media, forum rumours, we should always rely on expert help, and our health and budget will be grateful for that as well.

Photos:

Pixabay.com; PTE GYTK/Lókodi Dávid