Why Taiwan needs to shake its prescription drug habit

Taiwanese doctors prescribe drugs to just about every patient, many completely needlessly. This is creating a nation of people with weak immune systems and also helping to fuel the global antibiotic crisis

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Tamiflu.

Tamiflu. (By Wikimedia Commons)

TAIPEI (Taiwan News) -- Dealing with a nasty bout of the flu was not how I envisaged spending the first few days of the Year of the Dog. But being ill has given me another first-hand experience of Taiwan’s healthcare system, which has left me with both positive and negative feelings.

Firstly, when you are ill in Taiwan, you can get seen fast. We called into the local doctor's clinic at around 8 p.m. and within 10 minutes were sat with the GP. She checked me over then explained, in pretty good English, that she needed to do a quick test to see if I had flu or just a regular cold. This took another 10 minutes, after which she told me I had Type B flu and prescribed me various pills to make me feel better.

She also looked at my 3-year old daughter, who was just starting to show some of the symptoms and, without doing the tests, prescribed medication for her too. Within half an hour we were back at home and had only been relieved of around NT$200 (US$6.80) for my treatment.

As service goes, this is pretty good. Taiwan is not like the U.S., where many people cannot afford to see healthcare professionals when they are unwell. It is also not like the UK where the National Health Service (NHS) is notionally free to all at the point of use, but actually getting to see a doctor can be almost as hard as meeting the Queen, and most people have to resort to queuing for hours in A&E (ER) to get emergency medical treatment.

The easy and affordable access to medical professionals is something that Taiwan should be proud of. I have nothing but high praise for this. My concerns are more about what happens when you see a doctor.

After testing positive for flu, I was prescribed no fewer than five separate pills, all of which were packed up for me in neat little sealed paper bags, with drawings of Hello Kitty and Snoopy on them. I was not given any of the paperwork that would have come with this medication, but instead a single sheet of paper in Chinese which listed their names, the doses to take, and the prices I was having to pay for them.

Most Taiwanese people will rush home and begin to take this cocktail of pills immediately. I have always been a bit more cautious when it comes to medication so decided to do a bit of research.

My first port of call was the NHS website. In an effort to help people diagnose their own conditions, the NHS has developed an excellent website based on the latest medical research and advice, where you can research conditions and symptoms and then find out the best treatment and whether you need to see a doctor, go to the hospital, or even call an ambulance.

Their page on the flu is very clear. If you have flu, you need to keep warm, get as much rest as possible, drink plenty of water, and take either paracetamol or ibuprofen. It does not advise you to see a doctor or to take up to five different drugs.

One of the drugs on my list here was ibuprofen, but as the medication has been put together, I do not know which pill that is. Of the other pills in the packet, only one name turned up any information on the internet and that was a cough-suppressant. The other two are drugs that I know nothing about and have no idea of what they do or their possible side effects.

The one drug that did come in its proper box was an anti-viral drug called Tamiflu. This was a drug I recognized the name of as it caused quite a scandal in the UK a few years back. Back in 2014, a study published in the British Medical Journal found that Tamiflu had a negligible effect on Flu suffers when compared to those taking a placebo.

It found that Tamiflu shortened symptoms by just half a day, but given the possible severe side effects, which include nausea, vomiting, psychiatric and kidney problems in adults, and vomiting in children, concluded that the benefits of taking it did not justify the possible risks.

Subsequent studies have challenged these findings, but last year the World Health Organisation (WHO) downgraded Tamiflu from a "core" to "complimentary" drug and now only recommends its use to seriously ill hospital-bound patients.

My question is why Tamiflu is still being prescribed to me and also my 3-year old daughter here in Taiwan? Neither of us falls into the WHO definition of a suitable patient. Some research on the Ministry of Health and Welfare (MOHW) site shows that guidelines are that Tamiflu should be given to patients who are very young, very old, overweight, asthmatic, or have existing health conditions.

But why is this the case, when medical evidence shows that this drug has minimal benefits and potentially serious side effects? Surely, these groups are more likely than most to suffer badly from these side effects.

The Tamiflu example is just one example of what seems to me a fairly systemic problem with Taiwan’s healthcare system. The ease with which you can see a doctor and the affordability of doing so means that people here go to the doctor with every little ache and pain, cough and sniffle that they have.

And when they do go, they have become accustomed, nay they expect, to be prescribed something to make the better. And doctors are all too willing to oblige. Why would they not be? This is how they make their money. Every time they see a patient and prescribe some medication, they can send off a nice fat invoice to the MOHW.

This habitual prescribing of medication for every little ailment is undoubtedly one of the main reasons why the National Health Insurance system in Taiwan is running at such massive deficits. But it is also likely to be causing an imminent public health crisis too.

When people are taking drugs for every possible ailment, they are not allowing their immune systems to develop any resilience of its own. As a result, people get ill quicker and should there come a time when the drugs stop working, they are facing real problems.

This is a real possibility at the moment with the issue of antibiotic resistance being viewed by the WHO as “one of the biggest threats to global health, food security, and development today.” Yet, in Taiwan, antibiotics are still handed out like candy to patients with any old cough and cold, regardless of whether they will have any effect or not. This is likely to be fueling a problem, not only here in Taiwan, but around the world.

So, what is the solution? It needs a fundamental culture shift that may be hard for many Taiwanese people to accept. Doctors need to be stopped from prescribing unnecessary medication. This could be through direct regulation or changing the way they are funded to remove incentives for prescribing medication.

But Taiwanese people also need to learn that they do not have to go to the doctor whenever they feel a bit under the weather. To encourage them to take responsibility for their own health, MOHW could do worse than seek to introduce a comprehensive self-diagnosis website, similar to the one operated by the NHS in the UK. It would offer clear, trustworthy medical advice, and encourage those with minor conditions to look after themselves rather than trouble the doctor.

Using this site and social media to push out advice and guidance when there are outbreaks of viruses such as the flu that I am still suffering from as I write this, would also be a positive step forward.

I certainly would not advocate making it harder or more expensive to see a doctor in Taiwan. But to improve public health, make much-needed savings in the National Health Insurance scheme, and improve public health in Taiwan, better information and the ending of a culture that sees people visit the doctor every time they get a headache would be a big step in the right direction.