Over-The-Counter Drug – Need to Know Its Benefits and Detriment

The OTC drug market has grown rapidly over the past few years. Thanks to the major players in the market, such as Pfizer, Johnson & Johnson, Sanofi, and GSK, focusing on OTC drug development and the conversion of prescription to OTC, the other market players have also been influenced. The diversity of pharmaceutical companies focusing on OTC has helped the market flourish with a faster growth rate.

Nevertheless, there are still many issues that hinder the market’s growth. Many safety problems are inherent to OTC drug purchase. With increasing safety issues, the government has tightened the rules to control purchase.

Time- and Money-saving
As of 2012, there are over 300,000 OTC drugs in the market, and according to the Consumer Healthcare Products Association (CHPA), annually a total of 2.9 billion retail tips purchase OTC products. These drugs help the patients in saving time that is spent on doctor visits and diagnostics test for minor ailments. Also, this saves money for the consumers, which is needed to visit a physician and on prescription.

Cost-saving by Healthcare Systems
OTC medications reduce the necessity to visit the doctor/physician. This saves resources for the healthcare industry in particular, thereby allowing it to divert its resources to more pressing healthcare issues, which would require physician involvement, such as diagnosis and treatment procedures for serious conditions. OTC medicines provide access to safe medication for nearly 180 million patients, while, at the same time, saving capital for the healthcare industry. Self-care via these medications is estimated to contribute to savings as high as USD 5 billion to the taxpayers and consumers in the United States annually. As per CHPA, OTC medication saves around USD 102 billion for the US healthcare system annually.

Self-Control over Health
The OTC medications provide the liberty to patients to eliminate the need to visit a physician or other clinical setting for common ailments. Instead, they can easily procure medications to address their ailment by procuring drugs without a prescription. According to the Consumer Healthcare Products Association, around 81% of the adult population is using OTC medications. It is being helpful in providing symptomatic relief to around 60 million people. The statistics show that the consumers are aware of their health conditions and are paying attention to the treatment. OTC medication helps people meet healthcare needs and empower individuals about health management.

Product Innovation
OTC drugs that can treat multiple symptoms are another example of innovative products. Innovation is also resulting in improved performance, in terms of speed, strength, etc., thus improving the length of the effect. The diversification of the product is also achieved, as targeting different age groups – children, adults, woman, and old people with different products – are emerging and will drive the OTC drug market in future. The manufacturers of OTC target the women group, resorting to angles like pregnancy, weight loss, and even self-expression, which leads to new innovations. Similarly, OTC brands target children groups, with innovative offerings that consider two key drivers: enhancing the fun look and feel, and making it easier for parents to administer the dose to their kids.

Teen Drug Abuse
According to available statistics, around 12% of teenagers have admitted having abused OTC cough syrup. The major abuse of cough-and-cold medicines is seen among the teen population. Other medications include the usage of pseudoephedrine, marijuana, and diet pills. The major reason behind OTC abuse is the lack of education in teens about the dangers associated with OTC drugs. The parents are not well-educated about the adverse effects of OTC drugs, nor do they show interest to take the advice of physicians on this. This ultimately leads to hazardous casualties that can affect health or even lead to death.

Usage among the Geriatric Population
According to statistics, 40% of the OTC drugs are used by the geriatric population of age 65 and above. The geriatric population suffers from one or more diseases and are always on multiple medications. Sometimes, the OTC drugs purchased can cause the risk of drug interactions, leading to adverse drug effects. Other OTC medications, such as motion sickness pills and painkillers, that are commonly used by the elders cause hallucinations, stomach, and kidney problems, which can be considered as dangerous side effects for the geriatric population.

Usage in the Pregnant Population
Most of OTC drug labels carry the precaution about whether it can be used by pregnant women or not. However, due to negligence, people tend to use OTC drugs without proper knowledge, which may lead to life-threating situations. OTC drugs, such as Aspirin and Ibuprofen, should be avoided during the pregnancy, as they have shown adverse effects on unborn children or complications during delivery.

OTC Drugs through the Internet
With the development of the internet technology, medicines are now available at the doors. Sexual performance medicines are one of the products that are sold through the internet at a high rate. These medicines are used on over-dosages and are usually taken along with the alcohol. Research shows that sexual medicines have a reverse effect on sexual performance, when taken in combination with alcohol and can cause major heart problems.

The Role Of The Brain In Addiction

Technology has its mighty hand over every field in the world now. And since the base of technology is science, so how could medical sector not undergo changes! Neuroscience has always been an area of immense complexities and curiosities. Advances in this sector has allowed doctors to dig deeper into the brain and even study minutest of changes that happen due to substance intake.

When we talk about addiction as a brain disease, the reward system of the brain plays a very important role.

Physiologically, limbic system is the brain’s reward system. Mesolimbic and mesocortical pathways (Mid-brain) have our cognitive control and functions which would be both reward related and aversion related. Reward related functions are always stronger and more motivating than aversion, hence drug abuse behavior is stronger in addicts. The reward system connects certain structures in such a way that they generate the feeling of pleasure for certain behaviors or stimulus given to the body. In day-to-day life, it is activated by healthy, life-sustaining activities like eating and socializing. But ‘Drug Abuse’ is another behavior that generates euphoria, which is enjoyed by the mind. And human nature is to repeat those actions that give us some definite satisfaction. The limbic system does more than just giving a reward response. For any behavior to be reinforced, it has to be first registered as pleasant to the mind and body. Limbic system in the brain recognizes our positive and negative emotions, which very well explains, how our body and mind get dependent on any psychoactive mood altering substance.

However, with recent developments, neurobiology has been able to study how addiction is related to the brain. Researchers and scientists studied the brain’s reaction to different substances and discovered that drug abuse actually alters the chemical makeup of the brain, which is what causes addiction and they named it as a ‘Brain Disease.’

Since the brain is placed as the epicenter of human activity, it is the initiation point of every phenomenon that occurs. Whatever we feel, experience or think, all is first registered by the brain and within lesser than nanoseconds, it commands us to act. It communicates through neurons, neurotransmitters, receptors and transporters. Yes, it is very complicated and sounds mystical too (specially to people like me who have not studied biology after high school)

How do Drugs Affect the Brain?
Psychoactive substances interrupt with the communication systems of the brain. They interfere with the way a message is transmitted and sent to its defined destination. No matter how much people say that cannabis would not be called a drug, it is a plant, but the reality remains unchanged, which is, that everything has certain chemical composition. For example, Heroin and Marijuana’s chemical structure are like copies of a natural neurotransmitter. Amphetamines mimic catecholamine neurotransmitters, causing general physiological changes which prepare the body for physical activity and fight-or-flight response. So, the moment the body is intoxicated with a drug containing amphetamines or its derivatives, it starts reacting in unnatural ways by raising blood pressure, increased alertness resulting in sleeplessness, blood glucose levels. They can easily activate neurons, giving various directions to the body to react in a different way, than would a natural neurotransmitter would! Cocaine can make a person delirious, because it releases natural neurotransmitters in bulk and blocks the natural recycling process of neurotransmitters by the brain. Amphetamine causes drug tolerance very quickly and rapidly too.

Chronic addictive drug use causes alterations in the process by which information from a gene is used to synthesize a gene product- RNA or Protein. Nigrostriatal Pathway is a dopaminergic pathway that plays an extensive and unavoidable role in addiction. It comprises of Transcription Factor, which is a protein that controls what all information has to go from the DNA to the messenger RNA. Psychoactive substances block, many of the neural and behavioral alterations that are to be taken to the RNA. Altered dopamine transmission is the first thing that comes to notice in cases of drug abuse.

These have been many studies extensively done by medical science researchers on addiction. There is a wide range of chemicals that people use to reach a euphoric state. But the gist of it all is, that they play with the normal functioning of brain by altering the natural chemicals that ought to be there.

How Does the Reward System Work?
Whenever a person happens to do something that takes him to a different state of mind for a while, like reaching the oomph point in a sexually pleasurable activity, treating the taste buds with a new and a very different flavor or winning an excessive amount of money or any other valuable resource that he could use to be really rich, the brain takes it all in the same way. It activates the same gland and releases the same chemical Dopamine, which functions as a neurotransmitter, in all scenarios that seem to be pleasurable or exciting. Similarly, whenever the body receives an antibody that becomes too exciting for it like any drug, chemical or alcohol, the body releases certain amount of dopamine or cuts down its level. It is a problematic scenario is there is too much or too little of dopamine released by the brain. Drugs are addictive because they release up-to 10 times more dopamine than a natural neurotransmitter can! But when the body gets tolerant to the same drug and its amount, it can even cut down its normal release of dopamine!

The Changing Face of Healthcare

Several significant forces in the last several years have been changing the way healthcare has and will continue to be delivered. The emergence of more unique ways to deliver care such as clinics incorporated into businesses and factories, the increased use of mid-level providers (nurse practitioners & physician assistants), the increase integration of technologies such as telemedicine and robotics and the shift from interventional reimbursement to outcomes reimbursement are just a few examples.

Compounding these are the ever-increasing costs of healthcare, the strain of funding Medicare on the U.S. economy, and the complications of insurance and healthcare payments under the affordable care act, ACA.

This has led to changes in how businesses intend to interface with the healthcare system going forward. CVS’s acquisition of Aetna will try to leverage healthcare delivery through their pharmacy structure. United Healthcare’s acquisition of DaVita hopes to leverage cost containment and resource control by directly controlling physicians. And the recently announced collaboration among Berkshire Hathaway, Amazon and J.P. Morgan Chase presents a yet unknown structure whose stated goals is improved quality and less cost. How they will implement their strategy is yet to emerge.

The decline in hospital admission over the last several decades has further led to restructuring by hospital corporations such as Tenet. Premise Health has emerged as a company placing physicians and other healthcare providers directly in corporate/business offices.

The big question then with these new ventures are how do organizations know what works financially and how do they track performance… In other words, how do you track, measure and value the relationships between cost and outcomes?

How can the analyst measure which methods(s) may generate better or best outcomes?

A simple return on investment, ROI, calculation will not provide needed nor valid insights. However, the use of cost-effectiveness analysis (CEA) would provide quite useful, valid and actionable information. CEA uses decision tree models to compare not only cost outcomes but effectiveness outcomes of various treatments on patient health and even on future healthcare usage based on various current actions. It can further be used to determine how effective a set amount of money spent on a particular treatment or method will impact outcomes (i.e. willingness to pay calculation). CEA models are flexible and can incorporate a wide variety of scenarios. As opposed to Big Data, CEA makes use of Broad Data so that comparisons of treatment modalities can be evaluated using real life outcomes. It can compare effects on a discrete problem such as a cancer tumor, or on chronic ongoing diseases such as COPD or CHF.

As the delivery of effective yet profitable, or at least cost effective, healthcare becomes more challenging, methods for evaluating treatments and programs become more necessary if not essential. Methods must be implemented to evaluate these new treatments and programs once they are in place so adjustments can be made. CEA enable organizations to both initially evaluate and subsequently monitor new methods and programs in a meaningful way.