The words of humanist philosopher JosΘ Ortega y Gasset (1833-1955) must have a somewhat hollow ring for Irish consumers who can no longer buy cheap, 300mg aspirin tablets. "What does the ordinary person car if he is not richer than others," he wrote, "when the world is a rich place and has streets, railways, hotels, telegraphy, physical safety and aspirin to offer."
Three hundred milligrams is the ordinary painkilling dose of aspirin used for the treatment of headaches and other minor ailments.
A number of disgruntled consumers have been airing their views in the letters on this newspaper and on radio. The 300mg aspirin is now only available over the counter as Dispirin, the soluble form. (There are two companies supplying 300mg aspirin on a prescription only basis).
Other brand-name aspirin preparations, available over the counter, include ingredients such as caffeine and quinine.
However, one south Dublin pharmacist does not lament the demise of over-the-counter aspirin per se and says he was not surprised by its disappearance.
"Dispirin is a little dearer but it's soluble and a safer aspirin," he says. When generic aspirin was available, he says he only stocked two or three containers as the demand simply wasn't there. People are now using other painkillers such as paracetamol and Nurofen, he says.
"Baby aspirin", which comes in 75mg, is now the major seller as it is used in the prevention of strokes and cardio-vascular conditions, he says, and adds that as this is sold largely to older customers with medical cards the price is not such an issue. Ninety-nine per cent of his aspirin sales are on prescription. Over-the-counter sales are negligible.
The 300 mg aspirin disappeared off the shelves as stocks ran out after two manufacturers ceased supplying the market late last year. David Keyes, sales and marketing manager with Bayer, the company which originally isolated aspirin in its clinically pure form, says they were only selling 30,000 300mg aspirins a year in the State. Generic products were outselling them and it wasn't commercially viable.
"A number of people have been shouting at us about the disappearance of aspirin because Bayer is synonymous with aspirin, but, quite frankly, if they were buying our product we wouldn't have had to stop making it," he says.
Attempts to contact Antigen, who were major suppliers of generic Irish aspirin were unsucessful.
The disappearance of cheap aspirin has focused attention on generic medical products. Prof John Kelly of the Association of Pharmaceutical Manufacturers of Ireland says generic drugs are made when exclusivity, under Patent Law or regulatory requirements, expires.
Usually, they are between 30 and 80 per cent cheaper than the cost of the original. Exclusivity is the reward for putting in the original research and development work on a drug.
In Ireland, generic penetration is low, at 10 per cent, compared to more than 50 per cent by volume in the UK and Germany, he says.
To be sold on the Irish market, all drugs, generic or brand name, must be approved by the Irish Medicines Board (IMB). The medical director of the IMB, Dr Joan Gilvarry, says the quality, safety and efficacy of a drug is evaluated. "If we're happy it is appropriate, then it gets a licence. The availability and pricing has nothing to do with us," she says.
The biggest generic seller in the over-the-counter market at present is the painkiller paracetamol. One inner city pharmacist says the price difference is significant with, for instance, a branded product, Panadol, costing £2.15 for 24 tablets compared to £1 for the generic made by Uniphar. However, she says customers tend to exhibit brand loyalty and many ask for the product by brand name only. They may be suspicious of the generic alternative.
Over-the-counter generic products may not be as visible as brand names so consumers, who are not brand loyal and who want to save money, should ask their pharmacists if a cheaper version of the product is available.
When it comes to prescription medicines, such as antibiotics and painkillers, GPs are the gatekeepers. They decide what to prescribe.
But Dr Brendan O'Shea, of the Irish Council of General Practitioners, says there are guidelines. The National Medicines Information Centre provides GPs with regular unbiased updates, in a series of systematic, planned newsletters, covering each area of healthcare on a rotational basis.
GPs are also swamped with information from drug companies, who often spend more of their budget on marketing and promotion, than on research, he claims.
Patients should be more pro- active in the management of their treatment, says Dr O'Shea. "I would encourage a far more discriminating approach from patients, and not just about cost," he says.
There is a financial incentive for GPs to reduce their prescription budget. Under the Indicative Drug Budgeting Scheme, doctors who reduce their prescribing budget for patients with medical cards get some capital funding.
While this has increased awareness of generic alternatives, Dr O'Shea says it also puts pressure on GPs to prescribe fewer or less expensive drugs for their GMS patients.
For instance, newer anti-depressent drugs are safer, have fewer side-effects, but they cost five to ten times more. "If somebody comes in with mild to moderate depression, do I treat it as aggressively as I can or do I try and save money?" he asks.
The European Generic Medicines Association suggests doctors should be educated at an early stage, during their university training, to use generic names for drugs. Possible savings should be explained to them.
Other useful suggestions, from the European Generic Medicines Association, include the establishment of a European database for health professionals with comprehensive, free and accessible information on trade names, active substances, side-effects, methods of treatment and prices of all marketed medical products.