I have a headache today. It is the kind of headache I’d associate with a morning after a late night drinking whisky around a camp-fire, characterised by the sensation that the meninges that cover my brain are peeling away from the inside of my skull. Last night I sat outside drinking pints of water reading about the history of the stomach. I do not think this headache is self inflicted.
I do think it is related to the ulcer inside my lower lip that has been there for the last 10 days. I know the ulcer is a sign of a worn down immune system due to late nights fretting about the healthbill and soothing crying children. I know that there is nothing I can do to speed up my recovery, no gels or ointments to put on my ulcer, nothing to boost my immune system. The claims of the drug peddlars mean nothing to me. Only a tincture of time, hopefully only a few more days, will resolve the ulcer and fatigue.
My headache however is another matter. I know from past experience that 2 paracetamol are curative and will see me comfortably through my afternoon surgery and with this in mind I went to a pharmacy. Like every doctor I know, I immediately scanned the shelves for the cheapest, generic version. Pharmacies are an interesting comparison to GP surgeries because in terms of culture and practice they have travelled further down the road that leads to free-market health-care consumerism. That same road we are all being shepherded onto with barely audible bleats of protest or criticism from people educated enough to know better.
I rarely go into pharmacies and I was struck by the amount of glitter on the packaging. It was like looking at cheap jewlery through my steamed up, post cycle ride glasses. Eventually I found the paracetamol. In search of a bargain I looked at the large pale-blue box with a picture of familiar white tablets on the front, but this was £2.75 for 24 dissolvable tablets. I was hoping not to pay more than 2p per ordinary 500mg pill. Further along the shelf was a booklet type packet with a green and yellow cover with silver edging at £1.79 for 14 caplets. Next to it was a similar packet with added red exclamation marks: £2.49 for 14 ‘rapid melt caplets’. I stood there for a couple of minutes before going to the counter and asking for a box of their cheapest paracetamol, 79 pence for 32.
It is all paracetamol. It all does the same thing, but it varies enormously in cost from just over 2 pence to just under 18pence per 500mg. The cheapest version was hidden behind the counter. The expensive versions were laid out at eye level in the main part of the store. The cheapest version is in a light-blue box, the expensive versions are in multi-coloured booklets with reflective covers.
About twenty percent of my patients do not speak english and about 10% are barely literate. Over 100 have learning difficulties, many more left school without qualifications. A large proportion of my patients are chronically anxious. It is very, very easy to take advantage of people like this.
And yet while I was pondering all this at the counter, a stressed young woman in a suit put down £1.79 by the till and waved a packet of 14 paracetamol melts at the pharmacist before hurrying out of the shop.
If we are so easily manipulated with something as simple as paracetamol, is it really so difficult to predict the dangers that await as we travel further down the seemingly one-way road of medical consumerism?