Of the many gaps in my medical knowledge, few can be more substantial than my grasp of over-the-counter drugs (OTCs). I rarely use OTCs myself and my visits to the chemist are limited to a quick raid on male grooming and contraception (extra long). As a child, I was once sent to fetch a tube of haemorrhoid cream for a relative with the unfortunate name of Anusol (the cream, not the relative). Try as I might to disguise the pronunciation (Anewsol, Annusol etc), the pharmacist insisted on loudly dispensing a tube of Anus-ol. On top of this trauma, I was chastised on my return home for throwing away the empty tube, which allegedly had one good smearing still left in it.
I was hoping to go another 50 years in blissful ignorance of what the pharmaceutical industry cooks up for minor ailments, but Mr Hickey put the dampers on that. He asked me whether the amoxicillin I'd just given him would interact with his 'Fennings Little Healers'. Unfortunately he hadn't brought the packet with him ('it's white with green lettering and a yellow top') and had no idea what Mr Fennings put in his little healers. I was about to phone my friendly pharmacist to ask his advice when I noticed something shiny and purple poking out from the top shelf of the bookcase. Yes, it was indeed the Over the counter directory—a veritable gold mine of bizarre products: Doan's Extra Strength Backache Pills, Indian Brandee, Jaaps Grape Saline Health Salts, Hofels Odourless One-a-day garlic tablets, Red Kooga Betalife, Potters Peerless Composition Essence ... How could I have lived so long and yet experienced so little?
Mr Hickey had nodded off by now so I seized the opportunity to educate myself. The OTC directory contains a fascinating array of multi-coloured, creatively titled but essentially very similar products. Just as we have far too many non steroidals and antihypertensives in the BNF, so the directory includes dozens of off-the-shelf offerings for every category (for pain alone, there are over a hundred in general pain, period pain, migraine, gum pain, joint pain, throat pain, bowel pain, etc). So of all the thousands of tonics out there, how did Mr Hickey end up with Fennings Little Healers? I was going to have to wake him up.
'My mum always used them. She's dead now, but they always remind me of her. So I take one every day.'
'Just to remind you of her?'
'And not for any medical reason?'
'I would have thought being reminded of your mum on a daily basis was a perfectly valid medical reason.'
And so the conversation ended.
William Osler once observed that our propensity to take drugs is what separates us from animals. But even he would have been bewildered at the sheer array of products now on offer. Choice is champion in our consumer culture. Presumably they wouldn't be on the shelves if the likes of Mr Hickey and his late mother didn't buy them.
Most minor ailments get better if you leave them to nature, but who can argue against a tablet that reminds you of your mother when many of us dish out little coloured dollops of surrogate love to our patients: 'My doctor must like me ... he's given me something to take every day that reinforces our co-dependent relationship.' Or as Lily Tomlin once put it: 'Reality is a crutch for people who can't cope with drugs.'