A country in which consumers made someone rich by purchasing millions of Pet Rocks is at some risk when growing numbers of drugs and other health care remedies become available without prescription, expert medical care, or careful thought.

Americans are collectively treating themselves with an increasing array of medications now available without any guidance but advertising or folklore, and often without adequate data about product safety and effectiveness.

The health product aisle of a Maine supermarket now looks like a pharmacy. It bulges with Zantac 75, Monistat, Cortaid, Tagamet HB, and other drugs previously available only by prescription. (Narcotics still have to be acquired by prescription or from the friendly street corner vendor). Mixed in are growing numbers of herbal remedies, including wild yam preparations (for impotence, depression, and birth control), St. John’s wort (for depression and stress reduction), and many others.

Simultaneously, big prescription drug companies have loaded both barrels of Madison Avenue with double-ought media campaigns designed to get patients to ask their doctors for specific prescription drugs. Among the best advertised are Claritin (allergies), and Hytrin. The latter is a medication that can reduce the urinary obstruction caused by an enlarged prostate in men, a concept wonderfully depicted in print ads by the release of a clothespin from the neck of a balloon full to the bursting point. “Oh, what a relief it is” has new meaning. The drug sale may go to the company with the best ads, not with the best drugs.

Some of this is not new, and much of it is legitimate. Paid providers of health care should not have a lock on remedies, and not every medication that works has to be sanctified by world-class research published in the New England Journal of Medicine. Smart consumers can and should make more of their own health care decisions. To some extent, advertising to consumers educates them about choices.

What is new is the growing involvement of the industry that markets Nissan pickups (by telling you that dogs love trucks) in the marketing of prescription drugs directly to the public. They will do so with slick ads depicting allergic patients sailing happily through fields of ragweed but saying little about cost, effectiveness, value, and safety.

Also new is the explosion of alternative health care remedies, and their growing success. The sales of St. John’s wort, which is probably effective for treating some mild depression, will reach $300 million in the United States this year. It will do so with little of the testing for effectiveness mandated for prescription antidepressants, though there is limited data suggesting some effect.

That kind of financial success, with minimal limits on marketing claims for usefulness, will drive the herbal remedy market into the commercial mainstream. It will give producers an incentive to sell more aggressively, and in some cases, more carelessly, to market vitamins and herbal medicines as if they were selling hair care products and batteries. Hootie and the Blowfish brand of Yam Essence is unlikely, but if Michael Jordan isn’t endorsing a vitamin for middle-aged baby boomers in 15 years, his agent is asleep.

The combination of big business marketing drugs directly to consumers and a public that is reluctant to get informed will make for a lot of bad medical decisions in the privacy of one’s own home. More angina that felt like heartburn will be treated at home with acid blockers until it is too late. That will be the price for growing consumer control of personal medical care.

There is no going back, however, no putting this medical toothpaste back in the tube. Too much freedom would have to be sacrificed, and a country that has allowed the private purchase of automatic assault weapons is not going to give up the right to choose its own heartburn medications. Moreover, among the plethora of folk remedies are good medicines, although it is often difficult to tell which is worthy and which is worthless. Many of today’s most important medical breakthroughs are the result of what were once thought to be wacky ideas, including hand washing.

This society can handle the freedom, but not without collective responsibility.

The medical community needs to devote more research to herbal and other folk remedies, to identify those that are truly effective and safe. To this point it has primarily whined in frustration and fear; frustration at the competition, and fear of the consequences for those patients who should be seeking more mainstream alternatives. In doing so, it has largely failed to heal itself, to examine what it is about modern medicine that produces such a huge market for other options.

Those selling what were formerly prescription medications, and hot herbal remedies, need to act responsibly and be held accountable for their claims and advertising. They should be subject to the same limits on effectiveness claims as prescription medications. Direct advertising of prescription drugs to consumers needs to be closely monitored, by the buyer and the Food and Drug Administration.

The most responsible party of all, however, must be the consumer. When buying over-the-counter remedies of any kind without guidance from personal health care providers, or choosing prescription medications on the basis of clever ads, the buyer must beware. There are those in this world who would sell eye of newt if a profitable market could be generated for it. The American medical profession may also be motivated by money and may not always be right, but it would never prescribe pet rocks.

Erik Steele, D.O. of Bangor is the administrator for emergency services and pre-hospital care at Eastern Maine Medical Center and is on the staff for emergency department coverage at six hospitals in the NEWS coverage area.