Consumer Knowledge of Over-the-Counter Phenazopyridine

One of the landmark articles in family medicine is Kerr White’s 1961 article (1), later replicated by Green et al. (2), on the ecology of medical care. The recent article by Dr. Shi is a beautiful illustration of “the boxes” highlighted in the two landmark articles.

Kerr White’s basic premise was that too little medicine occurred where most medical research took place in the early 60s (and, well, today). This formed one basis for the development of our specialty, moving the focus of a research and training away from the tertiary care center and out into primary care. Still, according to White and Green, most people with a symptom do not seek medical care from their physician; they never make it to the doctor. This opens up a wide area of study.

Dr. Shi’s article on the consumer knowledge of over the counter phenazopyridine is an excellent example of that type of research. It evaluates purchaser knowledge of the indications and the behavior on the use of a former-prescription-now-over-the-counter medication. Obviously, this has important ramifications for the understanding of patient behavior, and it also potential implications in public health and policy.

This type of work can be extended to other critical areas, such as the recent discussion in Great Britain to give statins over the counter status or the recently approved (in the US) Plan B emergency contraception. The point is that just as the traditional researchers of the 60s focused on their little box of those who had been hospitalized or who had sought care at a tertiary care center, we in family medicine begin to get fixated in our practice-based research world evaluating only patients who come to see us. Expanding our focus out into the community does a service not only to our specialty but also to the society at large.

Another ‘small’ point deals with affiliation and conflict of interest. It is refreshing to see that Dr. Shi’s article reported no conflicts of interest, a rarity in drug studies. More importantly the article’s five authors represent 7 institutions and have training leading to 6 different degrees. This is an excellent example of a multi-disciplinary approach that this one young researcher has successfully used. It can serve as a model for both beginning and seasoned researchers.

1) White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med 1961;265:885-892.

2) Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM. The ecology of medical care revisited. N Eng J Med 2001;344:2021-2025.

Competing interests:   None declared