I Want a New Drug

Like millions of other folks around the world, I have been sick with the flu recently. That's why I've been silent, though I hope to resume normal service soon, both here on the blog and on the Prague Cast. Your patience is appreciated as I get back on track.

Getting sick is never pleasant, especially once you're an adult and getting sick no longer means staying home from school and lying on the couch watching Nickelodeon while eating Chicken and Stars soup. Getting sick abroad is even less fun. Except for those people who think that taking medicine is for the weak (How do you people LIVE?!?!), most of us, when we get sick, head down to CVS or Rite-Aid or Boots or whatever, get the name brands or medicines we know and trust, and head home to nap a lot, drink juice, and hopefully get better. We know you can't cure a cold or the flu, but we try to alleviate our misery, and maybe shorten its duration.

Why is that thermometer so big? Is it meant to go...elsewhere?

Here in Czechia, however, things are a bit different. For starters, if you want any sort of medicine--from aspirin on up--you have to go to a lekarna, which is essentially a pharmacy. You won't find any drugs at the supermarket or the corner shop, and there is even a type of store called a drogerie (literally "drug store") that doesn't sell any drugs. Instead, imagine a CVS or a Boots, and take away all the medicines and the pharmacy desk--what you have left is a drogerie, with haircare products, paper towels, lip balm, etc. So, that's no help for drugs, though it *is* where you need to go for cough drops and other cold/flu aids that aren't drugs, because those aren't considered medicines. Confused yet?

Anyway, so you go to a lekarna, which are, fortunately, everywhere, and can be found with this welcoming symbol:

Yup, just look for the green cross with the snake on it.

When you walk in, though, you may be surprised to find a seemingly empty store, with just a few counters--more of a bank set-up than a store. Something like this:

At least get some impulse items in there or something.

Some pharmacies do put selected items out on the floor for sale, but most places, most of the time, keep everything behind the counter. There's a desk for prescription drugs, and one for everything else. You wait your turn, and then ask the nice pharmacist for help with what ails you. The classic drugs like aspirin, paracetamol/acetaminophen, ibuprofen, etc. are pretty common, but after that, it starts getting harder to find exact matches. Formulations are different, brand names are different, and entire families of drugs are simply not available directly from the pharmacist.

One of my early forays into lekarna life was when I went in search of a sleep aid. Americans add sleep components to *everything*, but there are exactly zero non-prescription Czech sleep aids that contain actual drugs. Instead, you can a) try to find a medicine that, as a side effect, causes drowsiness (not a good idea), or 2) go herbal.

Valerian: not just a disgraced Roman emperor!

Yes, herbal medicines are also kept behind the counter at the lekarna, and unless you know going in what you're looking for, it can be easy to be confused. Now, I don't want to disparage all herbal medicines--there is, for example, some evidence that valerian root can be used as a sleep aid--but the evidence isn't always super strong that they have any real effect. There is a good reason that, in America, the FDA doesn't treat them as medicines; it's because they're not. The packaging of these products, however, often looks like what I think of as "drug" packaging, complete with weird brand names.

Vitango! Which is actually just rose root extract, which may (or may not) be effective for...depression?

While Vitango, pictured above, is mainly marketed as a stress reliever (which it isn't, but whatever), some herbal medicine practitioners think its active ingredient, rose root extract, can alleviate depression. And this is where I start getting angry. Depression kills people. It is not something to be treated on your own with an herbal extract that is trying to look like medicine. If you put all the medicine behind the counter with the pharmacist, it's only rational to conclude that they are all, in some ways, equal. And they decidedly are not.

Which brings me, full circle, to this...

Long, unpronounceable name? Sure sounds like medicine!

When I went in to get my flu palliatives, there was, behind the counter, a bunch of boxes like the one above, in the cold/flu section, with a large "Sale" sign on them. As I had already prepared my preferred drug list, I passed on the mystery box, but I made a note of the name and Googled it later. Maybe this was some great drug, unknown to American medicine!

Oscillococcinum, it turns out, is a common *homeopathic* remedy used to fight the flu. This remedy was created by Dr. Joseph Roy who, during the Spanish Flu pandemic of 1917-18, thought he found a bacteria in flu patients, which he named oscillococcus, so named because it oscillated. He later "found" the same bacteria in other sick patients, and believed it caused everything from chicken pox to cancer. So, he looked and looked until he could find a way of treating it, before he isolated the bacteria--in duck offal. Homeopathy being based on the idea of treating like with like, he made an extract of the duck offal, and said it would treat the flu. Modern Oscillococcinum uses a different breed of duck, but otherwise, it is essentially the same remedy Dr. Roy prepared: namely, a 1% solution of duck offal extract, diluted 200x over. The final weight of 1 g of Oscillococcinum is .85g sucrose, .15 g lactose, and literally no duck offal at all. Homeopathy!

Obviously, this is all utter twaddle, for a variety of reasons: A) No one else has *ever* been able to isolate Dr. Roy's so-called oscillococcus bacteria. Literally never. Which is probably a pretty good sign the good doctor was either seeing things or was a fraud. 2) We now know, with great confidence, that influenza, along with chicken pox and measles, is caused by a virus. So, even if this phantom bacteria were real, fighting it wouldn't help your flu. III) Lastly, let's not forget, HOMEOPATHY IS TOTAL BULLSHIT. Seriously, if you haven't read a lot about homeopathy and need a good laugh at the stupidity of humanity, have a quick Google. It is snake oil of the worst sort.

All of these pesky facts, however, have not prevented Oscillococcinum from becoming one of the 10 best selling medicines in France (Who says the French are sophisticated?) and popular all over Europe, including here in Czechia. Needless to say, I did not rush back to the lekarna to get myself some Oscillococcinum, though I was temped just to ask the pharmacist behind the counter if they *actually* believed in its efficacy. And, if they didn't, if they knew it was a total sham, were they ashamed to have to sell it to idiots who thought it would help their flu?

So, in conclusion, if you're planning a trip to Prague, it's probably a good idea to bring any over-the-counter medications you might need with you when you do so. And maybe bring some extra for any sniffly Americans you find along the way.

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P.S.--This entire post, especially the fun stuff, was inspired by the excellent podcast Sawbones: A Marital Tour of Misguided Medicine, which I mainlined during my convalescence. It's funny, informative, and clear-minded, and I highly recommend it.