Anti-colds, cough syrup… In pharmacies, the business of useless (and dangerous) medicines – L’Express

Like Humex, Dolirhume or Actifed, “not recommended” since last October by the National Medicines Safety Agency (ANSM), many self-medication remedies are the subject of alerts for their toxicity. L’Express was able to obtain the list of remedies to “discard from care” from the magazine Prescribe, who revealed the Mediator affair. Around ten seemingly harmless molecules sold without a prescription appear in this reference document, which must be published before the end of the year.

A little cough? Pentoxyverine disrupts the heart and causes allergies. A sore throat? Maxilase causes serious skin disorders. Smecta does not help you stay hydrated during temporary diarrhea and, if consumed too often, can cause lead poisoning. Metopimazine can cause sudden death, and has little effect on the minor nausea for which it is recommended. Against osteoarthritis, glucosamine is no more effective and causes hepatitis.

Many scientists are surprised to see so many products available upon simple request from the public, without any doctor having made a diagnosis: “These drugs are used for benign problems, which heal themselves. more than half of them are very old and have never demonstrated effectiveness. Worse: if they are given to people likely to react badly or consumed with other substances, in too high a dose, they cause very serious adverse effects”, regrets pharmacologist Jean-Paul Giroud.

Most of these drugs are promoted through advertising posters. Enough to annoy a little more the many whistleblowers like Prescribe, Jean-Paul Giroud, or the No FakeMed collective, very present on the issue. “If these molecules are still on sale, it is because they are all still authorized by the European Medicines Agency, the main reason why pharmacies leave them on the shelves,” retorts Philippe Besset, president of the Federation of pharmaceutical unions of France.

Code of ethics requires, the health of patients takes precedence over the economic interest of selling a product, recalls the unionist. Enough to silence the mercantilism complaints regularly addressed to the profession: “Everything that is sold behind the counter has been studied and evaluated by the authorities. And we have no right to recommend something less effective or less sure under the pretext that it brings in more”, recalls the specialist, head of one of the two main unions.

The fact remains that not everything that is authorized is necessarily good for your health. This is evidenced by the imbroglio around anti-colds: the ANSM recommends against them, without withdrawing them, because it is the European Medicines Agency which has the last word. Taking a contrary decision would sow confusion, explains the ANSM to L’Express. So these sometimes harmful tablets are still sold without a prescription despite twenty years of official reports calling for their restrictions.

One example among others… “Such legal bogs are common and limit withdrawals,” says an expert from the European Agency. When the institution was created, the pharmacopoeia authorized in France was preserved. Many molecules no longer meet standards, but re-evaluating them one by one would take years – just the re-evaluation of pseudoephedrine will take a year. It is not possible to reopen files just as a precaution.

Beyond this regulatory and diplomatic aspect, certain molecules are also kept because they are of interest, even if this is not medical, explain the pharmacologists. “In the case of a cold, if you don’t sleep because of a blocked nose, taking pseudoephedrine can avoid sick leave. This is not nothing, and this is also what the authorities are looking at,” illustrates Philippe Besset, convinced that Europe will keep cold medicines, notably for this reason.

Therein lies all the complexity of “without a prescription”, which represents a third of purchases in pharmacies, according to NèreS, the federation of manufacturers in the sector, a figure which has been increasing in recent years. “Patients want to take something. Yes, in pharmacies, there are molecules that are not very useful but the disadvantages are known, and pharmacists can limit the risks. Isn’t it better to offer these solutions and prevent patients from reporting on the Internet or ask their butcher for tips?” adds Martial Fraysse, member of the Academy of Pharmacy.

Useless, ineffective… A large part of this very old pharmacopoeia in reality only serves to make the placebo effect work or to reassure. Excessive restrictions would thus risk further congesting medical practices, while many French people resort to self-medication to remedy appointment delays with their general practitioner. Or to further boost sales of food supplements authorized in pharmacies, which are booming because they are driven by widespread distrust of science.

Hence this observation: “Given the scarcity of doctors in certain places and the difficulty in obtaining a medical consultation within the correct time frame, these medications can be useful against certain manifestations, even if these relate to bobology”, believes professor of pharmacology Milou-Daniel Drici, member of the French Society of Pharmacology and Therapeutics. “Especially since by not being reimbursed, they do not draw on national solidarity and often keep the French pharmaceutical industry running,” he adds.

Humer, Phytoxil, Petit Drill… Aware of this particular role played by molecules without a prescription, the pharmaceutical industry is trying to impose its own solutions, called “natural”, supposed to be less risky than old pharmaceutical chemistry. A hit: “This year, food supplements took first place in visibility behind the counter, a place usually reserved for medicines without a prescription, a first,” explains Jean-Sébastien Eudes, co-founder of Fact, a firm specializing in pharmaceutical data.

To make life easier, more and more pharmacists are recommending these popular ranges. “At least the customer leaves with something,” says a Parisian pharmacist. But again, there are many problems. Because not all food supplements are harmless. After the health crisis, hospitals had to take care of patients who had overdosed on vitamin D. They thought that by taking a lot of it, they would strengthen themselves enough to fend off Sars-Cov-2. But natural doesn’t mean “safe.”

A great mix, too, beneficial for drifts. Faced with this trend, some pharmacists no longer hesitate to sell completely other products within their establishment. Stones with magical properties, and all kinds of “alternative treatments”, popular with patients. Contacted by L’Express, the Order of Pharmacists claims to invite its members “to pay extremely close attention to their offer within their pharmacies. […] The code of ethics aims to contribute to the fight against charlatanism.

Thanks to the 2023 social security financing law, recently passed by a new 49.3, pharmacists will be able to prescribe certain medications themselves against cystitis or tonsillitis. If everyone believes that this is progress and that by giving them this new place the French will turn less often to charlatanism, concerns are already rising. Because these new prerogatives are so many additional administrative tasks, while pharmacy staff have shrunk in recent years.