PILL POWER

If there are drugs out there that will make you smarter, sexier,
thinner, why should doctors control them?

"Feeling sluggish and forgetful? Try Cerezox, the cognitive enhancer
that makes you think faster and boosts your memory..."

Cerezox doesn't yet exist, but give it a few years and something like
it will. Memory boosters are on the way, along with dozens of other
supposedly rejuvenating, beautifying and energising chemical aids for
the ageing baby-boomer. Goodies currently in the pipeline include a
clutch of new appetite suppressants, increasingly subtle mood-tweakers
and, rumour has it, a Viagra-style product for women.

And whether they live up to the hype or not, the demand they are
likely to generate won't be limited to the clinically impotent, obese
or depressed. Already fuzzy, the distinction between pharmacology and
cosmetic pharmacology, between medicinal and lifestyle drugs, is about
to blur still further.

Well, let it blur. For too long we have put up with experts drawing
lines in the sand to decide who deserves to be prescribed drugs, not
to mention doctors handing out pills to people as though they were
children. And for what?

There is no compelling reason why drugs such as Viagra and Prozac
should not be sold over the counter and advertised like any other
product. In fact, there are good arguments why they should be. And
while few of these arguments are brand new, the sheer number of drugs
in the pipeline, along with growing public awareness, makes some sort
of action imperative.

The problems we face if we don't liberalise access to lifestyle drugs
have been looming for some time and can be seen most clearly in
Britain where ministers have already made clear that they will try to
ration lifestyle drugs or even ban their use by people who are not
clinically unwell. If this happens, demand for the drugs won't vanish:
people will simply buy them abroad or at exorbitant prices (and
possibly illegally) from mail-order outlets.

One way doctors have hung onto their prescribing monopoly is by
convincing us that we are too stupid to treat ourselves. But
prescribing through doctors does not necessarily curb drug excesses --
barbiturate and benzodiazepine addiction was created on a huge scale
by doctors, not despite them. Until this decade, when European Union
regulations started to bite, people in Spain and France were able to
buy many prescription drugs, including tranquillisers, at their local
chemist. Reports of addiction and overdoses were no worse than
anywhere else.

Obviously, certain safeguards need to be tightened before powerful
drugs could go on open sale. Drugs for children, those with especially
dangerous (and expensive to treat) side effects and antibiotics, which
could spread resistance, should be restricted. But appetite
suppressants, memory enhancers and other potential lifestyle drugs
should be sold at the buyer's own risk, providing the risk is made
clear.

Warnings-not to mix them with alcohol or other drugs, or to avoid them
if you have heart or liver problems-need to be made unmissable. And
pharmacists should extend the existing schemes by which they issue
smart cards which carry information about other medications, so the
issuing pharmacist will be alerted to possible bad drug reactions and
can warn the purchaser. Reckless individuals who ignore such warnings
are no more likely to heed the advice of doctors. We don't need a note
from experts to buy other potentially risky products such as alcohol,
weedkiller, or skiing holidays, so why single out drugs?

A healthy person simply shouldn't need drugs, you might say, but this,
too, does not stand up to scrutiny. It is natural to get wrinkly as we
get older; to lose some memory capacity and libido. It may even be
natural, given the unnatural nature of modern society, to continuously
fancy more food than we need or to feel mildly depressed. But what is
natural is not necessarily nice.

For centuries, we have sought pharmacological antidotes to nature's
nastier manifestations-lifestyle drugs are simply the latest. The
difference is that, because they are called drugs (as opposed to
herbs, unguents, or tonics), we have allowed them to make us so
nervous that we insist on people being definably ill before they can
have them. Thus we have relabelled shyness as social anxiety disorder,
unhappiness as sub-clinical depression, and night-time raids on the
larder as an eating disorder, buying into the myth that health and
illness are either/ or states when they are on a continuum.

Viagra fiasco

But that outlook could disappear fast as a new generation of drugs
that people actually want looms on the horizon-and as the information
revolution gathers momentum. Already, anyone with a mouse can find out
more about their ailments than their real doctor is likely to know-and
more about so-called "offlabel" uses for drugs: oral acyclovir, for
example, an expensive antiviral only available on prescription, is a
far more effective remedy for cold sores than the topical cream
available at the chemists.

As the Viagra fiasco in Britain revealed, it's futile to think you can
stop information getting out. For six months after the drug became
available in the US, Pfizer, its manufacturer, couldn't even mention
the drug's name in Britain because it was still awaiting its European
licence. Yet during that time, people could call up 20 000 sites and
140 000 web pages dedicated to the drug. The licensing authorities
eventually gave up and changed the rules.

In Britain, drugs companies have backed the status quo because its
National Health Service provides a guaranteed market and the medical
profession makes a wonderful sales force, with the added benefit that
if things go wrong, it is the doctor who is sued, not the maker. The
companies have also been warned that the cosy price-fixing privileges
they currently enjoy could be jeopardised if they push for
deregulation too hard. And doctors like the set-up because they retain
their status and their power.

What will bring the whole thing tumbling down is when patients
complete their current metamorphosis into consumers, get organised and
demand a change. It will happen, but not without a fight.

Rita Carter is a medical writer based in London