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Medicines and remedies

by Pauline Norris and Rosemary Beresford

For hundreds of years people have sought effective medicines and remedies. Māori used flax and other plants to relieve common ailments. Early European settlers relied on addictive drugs such as opium and morphine. Many medicines were dangerous or ineffective. Until 1946 it was not compulsory to label the ingredients in medicines.


Plants, pills and poultices before 1900

Early Māori medicines – rongoa rākau

Traditional Māori communities used medicines prepared by tohunga using fresh or dried plant materials. Common preparations included an infusion of flax root for constipation, koromiko leaves steeped in warm water to treat both diarrhoea and constipation; and kawakawa leaves for stomach upsets and toothache.

European medicines

Early European inhabitants also used medicines prepared from plants, such as peppermint for digestive troubles, valerian for insomnia and opium for severe pain. These were obtained from local missionaries or from supplies held by visiting seamen. In the 1840s, European settlers were advised to bring their own medicines with them if they could.

Patent medicines

Patent medicine was the common name for trademarked medicinal preparations sold under brand names. They could be bought at fairs, in general stores and in some pharmacies without consulting a doctor. Initially they were expensive to import. By the later 19th century, however, large quantities of these patent medicines were being imported from the United States and Britain, which lowered the cost.

Powerful brew

 

Chlorodyne, a popular patent medicine sold under various brand names in the 19th and early 20th centuries, contained ingredients like chloroform, morphine and extract of cannabis – a potent mix of highly addictive substances. Often fatal when taken in large quantities, it was implicated in many accidental deaths and suicides during this period.

 

The labels usually gave no indication of the medicines’ contents (which were commercial secrets), but did make extravagant and often unfounded claims about their effectiveness. They were usually mixtures of mainly purgative plants, such as rhubarb and aloes, some with soap and ginger added. These had a laxative effect which may have been of some benefit to users. Many contained opium and had a high alcohol content – up to 40% – which eased pain and produced a sense of well-being. Even children were dosed with these medicines, occasionally with fatal results.

Patent medicines were popular because they were extensively, attractively and persuasively advertised in magazines and newspapers and through trade or ‘show’ cards. Advertisements often included endorsements by doctors and testimonials from satisfied customers.

Beginning of the pharmaceutical industry

From the late 19th century, ready-made and fully-labelled medicines were manufactured by a growing number of international pharmaceutical companies. These medicines were developed after pharmacists and pharmacologists succeeded in isolating the individual active components of various plant extracts. The demand for these powerful medicines led to the development of large-scale manufacturing industries in Europe and the United States, and the creation of synthetic chemicals, including anaesthetics and analgesics (medicines that eliminate or reduce pain), such as aspirin.


Plant extracts to modern drugs, 1900 to 1930s

Regulation of patent medicines

The government attempted to regulate patent medicines at the beginning of the 20th century. Regulations issued in 1904 stated that bottles or boxes containing patent medicines were to be labelled in English with details of the ingredients they contained, together with the quantities of each ingredient.

Manufacturers responded that they would no longer sell their products in New Zealand. Distributors and individuals who sold patent medicines claimed their businesses would fail and patients would suffer if the medicines were not available. These protests were successful and the regulations were revoked. Listing ingredients was not made compulsory until 1946.

Out of print

 

Government attempts to introduce compulsory labelling of ingredients on patent medicine boxes and bottles was cause for concern to the Master Printers, Lithographers and Bookbinders’ Association. They believed that ‘printing and allied trades will be seriously affected, and much loss of employment by their workmen will result’ if the regulation was enforced and medicine stopped being sold.

 

The Quackery Prevention Act 1908 made it an offence to publish a false statement about the efficacy of any medicine. However, defendants could usually produce testimony that such remedies worked, so prosecutions were generally unsuccessful.

Māori healers were the target of the Tohunga Suppression Act 1907, which allowed the prosecution of any person ‘who misleads or attempts to mislead any Maori by professing or pretending to possess supernatural powers in the treatment or cure of any disease.’ Few successful prosecutions were brought.

Regulation of new drugs

The pharmaceutical industry expanded rapidly in the early 20th century as drugs were synthesised in laboratories and manufactured in commercial quantities. They were sold to the public by doctors and pharmacists in easy-to-swallow formulations such as tablets and capsules. Pharmacists were now less involved in the preparation of medicines.

The potency of these new medicines prompted governments to pass laws to control their sale and use. The Dangerous Drugs Act 1927 attempted to control potentially addictive medicines. The Poisons Act 1934 identified medicines which could be harmful (though were not addictive). Such medicines could only be sold by a pharmacist if a registered doctor prescribed them.

Effective medicines

Significant vitamins and hormones were identified by overseas researchers during this period. Insulin (used to treat diabetes) was first isolated in the early 1920s, and vitamins A, B, C and D were synthesised from the 1930s. Oestrogen was used to treat menopausal symptoms, such as hot flushes, from the 1930s. The important antibiotic prontosil was discovered in 1932 and used to treat people suffering from bacterial infections. This signalled the beginning of the ‘therapeutic revolution’ – the transformation that made medicines more effective.

Footnotes
    • Feilding Star, 23 November 1904, p. 2. Back

Prescription medicines, 1940s to 1990s

Free prescriptions

Until the 1940s most people had to pay for the medicines their doctor prescribed for them. Some belonged to friendly societies (credit unions), which owned some pharmacies, and for an annual charge could get subsidised medicines through these pharmacies.

In 1941 the government introduced the Pharmaceutical Benefits Scheme as part of comprehensive social security reform. The government funded medicines prescribed by doctors so people no longer had to pay pharmacists for these medicines.

New medicines

From the 1940s, pharmaceutical companies invested heavily in research. The many new and effective medicines included penicillin (antibiotic), hydrocortisone (hormone), antidepressants, cardiovascular drugs such as medicines to lower blood pressure, tranquillisers, antipsychotics and contraceptive pills.

These new drugs replaced many older products. For example, the introduction of antibiotics meant that wounds and skin problems could be healed by swallowing a pill, reducing the need for traditional approaches like poultices.

Increasing costs

The number of prescriptions dispensed increased greatly, as did the cost to the government. The average person received 3.45 prescription items in 1943 and 9.08 in 1986. Patient charges for prescription medicines were introduced in 1985 and increased in 1988, 1991 and 1992. By 1992 those on higher incomes were paying up to $20 per prescription item.

Alternative remedies

The introduction of effective new drugs increased public enthusiasm for modern medicine, but towards the end of the 20th century some people became more critical. From the 1970s the women’s health movement played a key role in stimulating debate about the safety of medicines and related products, particularly contraceptives. Alternative or complementary remedies became more popular. In the 1970s and 1980s the number of health-food shops selling vitamins and other nutritional supplements, and homeopathic and naturopathic remedies, grew substantially.


Access to medicines, 1993 to 21st century

PHARMAC

The government set up the Pharmaceuticals Management Agency (PHARMAC) in 1993 to manage state expenditure on medicines. The agency negotiates with pharmaceutical manufacturers to achieve reduced prices for particular medicines, which it purchases from a fixed budget. The main functions of PHARMAC are:

  • maintaining a schedule of subsidised medicines which doctors prescribe
  • managing subsidies on some medicines and some medical devices for public hospitals
  • overseeing special access programmes such as paying for medicines for people with rare health conditions
  • promoting the best and most appropriate use of medicines.

PHARMAC’s purchasing strategies have been criticised by manufacturers and sometimes by patients and doctors. Manufacturers have argued that some highly effective new drugs are not available in New Zealand, and that the country does not contribute to the costs of research and development. Patients and doctors sometimes say their choice of medicines is constrained. There have also been debates about whether expensive new drugs should be subsidised if they benefit only a few people.

However, PHARMAC has been very successful in reducing the cost of medicines. As a result, pharmaceutical expenditure in New Zealand is low and has not grown as fast as in many other OECD countries. In 2016/17 New Zealand spent $849.6 million, about $181 per person. New Zealand spends about 8.3% of its health budget on pharmaceuticals, compared to 12.1% in the UK and 17.5% in Canada. There is now widespread consensus that the PHARMAC model works well and all major political parties support it.

The development of new, very expensive cancer treatments is challenging for governments and insurers who pay for medicines in many countries. In New Zealand there have recently been vigorous public debates about two medicines: Herceptin and Keytruda.

Herceptin (trastuzumab) is a treatment for a particular type of breast cancer. In 2007 PHARMAC agreed to fund a nine-week course for people with early-stage breast cancer. This was based on an assessment of the costs and benefits of the drug, including the impact of long-term use on patients’ hearts. The Breast Cancer Advocacy Coalition led a public campaign for the funding of a 12-month course, as recommended in the UK. Eight women with breast cancer, the ‘Herceptin Heroines’, took PHARMAC to court over the decision amid widespread public and media controversy. A National Party promise to fund 12 months of Herceptin was implemented after National won the 2008 election.

Another public controversy surrounded Keytruda (pembrolizumab). In 2015 PHARMAC refused to fund Keytruda to treat melanoma because of its very high cost and because strong evidence for its effectiveness was lacking. This led to media coverage and lobbying by patients and doctors. In 2016 PHARMAC received an application for funding for a competitor drug, and after negotiations with both companies and further evidence from clinical trials, in mid-2016 both drugs became funded for melanoma. Debate about funding for Keytruda to treat other types of cancer continued.

Medsafe

Medsafe, a business unit of the Ministry of Health, is responsible for the regulation of therapeutic products (medicines and medical devices) in New Zealand. Its activities are governed by the Medicines Act 1981 and the Medicines Regulations 1984. Medsafe’s functions include:

  • approving medicines before they are made available to the public
  • deciding whether medicines are made available on prescription, or are on general sale at a pharmacy
  • monitoring the safe use of products
  • removing products from use if they are shown to be unsafe
  • licensing medicine manufacturers
  • approving applications to conduct clinical trials.

It is possible (but illegal) to purchase prescription-only medicines from overseas suppliers without a prescription by using the internet. Medsafe undertakes border control activities to intercept these items.

Controlled substance

Medicines tend to become more accessible over time, but there are exceptions. Pseudoephedrine, a popular over-the-counter remedy for blocked noses and sinuses, was reclassified as a prescription medicine in 2009 because of its use in the manufacture of the illegal Class A drug, methamphetamine (‘P’).

Prescription charges

Prescription charges were reduced substantially between 2002 and 2007 as part of the Labour-led government’s Primary Health Care Strategy, which aimed to make primary care (provided by a GP or public health nurse) more affordable. By 2013 most people paid $5 per prescription item for most medicines. In 2018 free prescriptions for children under 14 were introduced.

Regulation of natural products

In the 2000s the New Zealand and Australian governments proposed establishing a trans-Tasman agency to assess the quality and safety of pharmaceutical and natural medicines. It was argued that New Zealand was not large enough to effectively and quickly assess new medicines.

Critics of this proposal claimed that businesses manufacturing natural products would suffer, and that people who used these products would no longer be able to buy them as easily. In 2007 the government decided it did not have enough support to pass the necessary legislation, and the agency was not established. The production of natural and traditional products continued to be governed by the Dietary Supplements Regulations 1985 or the Medicines Act 1981, neither of which were seen by the industry as appropriate models.

The National-led government in association with the Green Party began planning a new regulatory scheme in 2009 and consulted widely with consumers, suppliers, importers, manufacturers and practitioners. The Ministry of Health noted that there was insufficient information available about the number and turnover of natural products in the New Zealand market to determine the likely cost of such regulations. Nevertheless, in 2011 a Natural Health and Supplementary Products Bill (later the Natural Health Products Bill) was introduced into Parliament, where it languished until 2017.

Natural Products New Zealand, which represented most major local manufacturers and practitioners, had concerns about the initial bill but supported it in its revised form. Their view was disputed by the New Zealand Health Trust, which launched a media campaign to discredit the bill, claiming that it would limit consumer choice and seriously damage the New Zealand natural products industry. In turn, Natural Products New Zealand asserted that 'misunderstanding and misinformation' was being promoted.1 The bill was not passed before the 2017 election, and it has not been reintroduced by the subsequent Labour-led government.

Footnotes

External links and sources

More suggestions and sources


How to cite this page: Pauline Norris and Rosemary Beresford, 'Medicines and remedies', Te Ara - the Encyclopedia of New Zealand, http://www.TeAra.govt.nz/en/medicines-and-remedies/print (accessed 5 June 2020)

Story by Pauline Norris and Rosemary Beresford, published 5 May 2011, reviewed & revised 23 May 2018, updated 1 Apr 2020