Where and how do you buy medicines?
Report by Rui Liu & Susanne Lundin
In order to understand where and how the Swedish public access their medicines, especially
prescribed medicines, an online survey was conducted as a pilot study during April and May
2016. Among a collection of 155 answers, the data shows that, although a majority of the
respondents feel hesitated and negative towards shopping prescribed medicines online, a
tendency is demonstrated that people would seek out medical assistance from other
sources in foreign countries if their need could not be satisfied by the current national
healthcare service. This might expose these vulnerable patients to the danger of falsified
medicines. Our findings point out the need to map out medical consumers’ shopping
patterns and call for more qualitative studies to understand this mechanism and to provide
the public with necessary information regarding shopping medicines in a safe environment.
Keywords: medicines, falsified medicines, the public, Sweden, attitudes
This report can be cited as: Where and how do you buy medicines? Report. Rui Liu & Susanne
Lundin, 2016, Department of Arts and Cultural Sciences, Lund University
Corresponding author email@example.com, Department of Arts and Cultural Sciences, Lund
university, Box 192, 221 00 Lund, Sweden
Table of Contents
Introduction ............................................................................................................................... 3
Demographic background of respondents ................................................................................ 4
Insights from the results .......................................................................................................... 18
References ............................................................................................................................... 20
This online survey was conducted during April and May 2016, aiming to understand how and
where the Swedish public access medicines, especially prescribed medicines online and from
abroad. The design and distribution were collaborated between the Department of Arts and
Cultural Sciences, Lund University and the Folk Life Archives at Lund University. This survey
was first edited by using LimeSurvey
, a free and open source online survey software. Links
to the survey in Swedish and English were then distributed via Folk Life Archives’ official
webpage, social media, targeted patient organizations in Sweden and the researchers’
personal contacts. 155 answers were collected in total, in which 152 answers were in
Swedish and 3 in English. This following report is divided into three parts. The first part
presents demographic background of the respondents. The second part shows the results,
both statistical and qualitative. Statistical results are presented in the form of pie charts and
bar charts, and qualitative results are thematized and discussed accordingly. The last part
provides some insights drawn from the results, and suggests further research directions.
Demographic background of respondents
Male Female I don’t want to answer this
12-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 100-
Number of respondents
010 20 30 40 50 60 70 80 90
Secondary education, less than 3 years
Secondary education, 3 years
post-secondary education, less than 3 years
post-secondary education, 3 years and over
Number of respondents
County (15 counties in total)
010 20 30 40 50 60 70 80
Västra Götalands län
Number of respondents
Results and discussions
1. What do you normally do when you feel sick?
Over half of the respondents choose to self-diagnose in the first place. Around one third of
respondents choose a combination of all three alternatives. The sense of “control” becomes
prominent here. As one respondent comments: “Depending on how sick I feel. Most of the
time one knows what goes wrong. I only contact the hospital if I experience something I can’t
manage by myself, or something that I don’t know what that is.” Choosing which measure to
take depends on whether the sickness is manageable with one’s own medical knowledge.
2. Do you recognize the following symbol?
Slightly over 1/3 of respondents recognize the symbol that indicates an authorised online
pharmacy. This result is aligned with that reported by The Medical Products Agency in
Sweden (MPA) (2015). What appears interesting is what people think about this symbol, in
other words, how effective this symbol communicates with the public. For further analysis,
see Question 5.
010 20 30 40 50 60 70 80 90
Call health care hotline 1177
Try to diagnose on my own
Make a doctor’s appointment or contact the
What do you normally do when you feel sick?
Do you recognize the following symbol?
3. Where do you normally buy prescribed medicines?
The majority of respondents choose to buy prescribed medicines via pharmacy stores. No
respondents in this survey appear to buy from online shops other than pharmacies. The
number of people usually buying such medicines from online pharmacies is small, as the
result shows, but it is unclear whether those online pharmacies are authorised or not.
Nonetheless, it is worth noting that some respondents comment that they also buy
prescribed medicines from other sources, including acquaintances in Thailand (“Bangkok via
acquaintances who live there”), shops abroad (“abroad, in the shop” or simply “abroad”),
friends, or contacts (“contacts, or on the street”). All of these respondents are Swedish, with
one of whom having immigrant background. This indicates such medicines may come from
informal and potentially harmful sources, which can be unsafe to consume. Question 8
provides some explanations to this behaviour.
4. Would you feel safe when you buy prescribed medicines from the Internet?
Slightly under half of the respondents do not feel safe to shop prescribed medicines online,
and the number of those who feel safe and the number of those feeling uncertain are close.
020 40 60 80 100 120 140 160
Other internet shops
Number of respondents
Where do you normally buy prescribed medicines?
Would you feel safe when you buy prescribed medicines
from the Internet?
Yes No I don't know
If taking into account the factor of age, it is interesting to see within each age group, the
older the groups are, the larger percentage of those who feel unsafe to shop prescribed
medicines online is (see the chart below). This result also confirms a research conducted by
MPA (2011) which shows it is more usual among younger groups to shop medicines online.
One possible explanation could be that younger people are more used to online shopping
activities in general and may feel more experienced to trade off risks about shopping
medicines online. This hypothesis nonetheless calls for further empirical researches.
In addition, given the rather large number of those who are uncertain about the safety of
shopping prescribed medicines online, it is worth mentioning possible correlations between
online shopping in general and online medicine shopping. E-commerce is flourishing at a
rapid speed in Sweden and online shopping in general has become one of the most common
ways to purchase products
. According to the recent report from PostNord Sweden (2016),
during the first quarter of 2016, beauty and health products are among the top 3 most
purchased items online among the public in Sweden. Although this online shopping trend
does not indicate an increase in shopping medicines online, it would not be insensible to
speculate some correlations between the two phenomena.
5. The following symbol indicates that an Internet pharmacy is legal and authorised in
Sweden. Does this symbol matter when you buy medicines online?
In this open question, mixed perceptions to the symbol are presented. A majority of
respondents give a straightforward and firm answer like “Yes” or “if I would buy prescribed
medicines online, this symbol matters. Probably not otherwise.” Meanwhile, there are
answers that demonstrate a sense of scepticism, not directly towards the activity of
shopping medicines online, but to the trustworthiness and reliability of internet. For
example, one respondent comments: “Not for me, since it feels too easy to plagiarize and
misuse symbols on the internet.”
20-29 30-39 40-49 50-59 60-69 70+
Number of respondents
Would you feel safe when you buy prescribed medicines
from the Internet?
Yes No I don't know
Besides the oppositional attitudes to this symbol, a certain number of respondents bring
about the correlation issue between the symbol and the quality of medicines. One comment
goes: “Yes, I partly consider this symbol as a quality stamp.” This authorisation symbol only
partly represents the quality of medicines from an online pharmacy, in the eye of consumers,
which means other standards or indicators are deployed when people decide if an online
pharmacy is a “good” one or not. One respondent says: “It is possible to have this symbol but
not being really legal. But together with other factors, it can be felt legitimate.”
Here, it points out a need to understand not only consumers’ online shopping behaviours,
but how they encounter and interpret the signs on any given online pharmacies. Only by
doing so can we thereafter learn if the symbol that stands for authorised legal internet
pharmacies can communicate effectively to consumers, and, further, identify what other
sorts of tools should be provided to consumers for a safe online medicine shopping
6. What do you consider when you buy prescribed medicines?
Many respondents consider this as a confusing question because “One only gets what one
should get when he shows the prescription, right?” It means that they subconsciously equate
the word “prescribed” to doctor’s prescription, which could indicate that these respondents
are highly likely to get their medicines through a formal procedure. Trust in doctors and
pharmacists is also clearly presented by straightforward comments like “I trust prescription
doctors”. Price and other factors listed in the question are not primarily concerned by such
On the other hand, this question is formulated to see how consumers check their medicines
upon purchasing, but some respondents turn around to these superficial indicators, instead
they are more concerned with pharmaceutical efficacy and reputation of a brand. A typical
comment goes like this: “That the medicine is effective, reliable and ethically trustworthy in
every respect. Clear information (is) important.”
7. Do you think it necessary to consult medical professionals before purchasing and
consuming prescribed medicines? If yes, who do you consult, doctors, nurses, staff at the
pharmacies, e-doctors or mobile apps? If no, please tell why.
0.00% 20.00% 40.00% 60.00% 80.00% 100.00%
Medicines that you have never heard of
What do you consider when you buy prescribed medicines?
The result shows that a high percentage of respondents consider consultations with medical
professionals are necessary before buying and using prescribed medicines, but some
interesting points stand out.
First, although doctors are the most preferred to consult, people tend to rank the severity of
their sickness, and then look for information and seek assistance from different sources
accordingly. This links back to the sense of “control” mentioned in Question 1. The most
serious sickness is for doctors, followed by nurses and pharmacists and lastly websites such
as Fass.se and Wikipedia. E-doctors are mentioned by very few respondents. Mobile apps do
not appear in any of the comments.
Second, how do respondents conceive professional advice? In some comments, one can see
that medical professionals are somehow instrumentalized and employed by consumers to
provide a second opinion, rather than a decisive recommendation. For example, one
comment says: “Because getting a prescription requires consultation with doctors, but I often
read on my own before the consultation and then ask for the medicines I want”. Another
says: “I want to know what the doctors recommend, but then I may not do exactly as advised
by doctors. But I reflect on their advices when I make my decisions”. Individuals also compare
advices given by various healthcare professionals, as one respondent comments: “I like it
when pharmacists say the same thing as doctors do. Then one knows that information can be
Third, respondents demonstrate a certain level of medical knowledge, in that many of them
realize that there might be conflict effects between different medicines. This is the essential
reason mentioned by respondents who think medical consultations with doctors are
necessary since they need medical professionals’ expertise to avoid medical conflicts.
Ironically, this also explains why a certain amount of respondents do not think such
consultations necessary. As one respondent comments: “Had experiences with doctors who
in several situations had prescribed medicines that would cause, for example, conflicts with
other medicines I am used to take. Don’t rely on the system we have in Sweden when it
comes to supervisions of patients’ medicine use.” Another respondent says: “Doctors – but I
have various experiences, for example, a doctor in Sweden (Huddinge Hospital) offered to
prescribe me penicillin “if I wanted”, although the same doctor had observed virus infection.
Odd but true. Significantly lowered my trust in the healthcare staff, not to mention the
Do you think it necessary to consult medical professionals
before purchasing and consuming prescribed medicines?
Yes No I don't know No answer
antibiotic resistance.” With these not so positive experiences, trust in doctors’ medical
expertise decreases, and the reliance on self-medication increases.
Fourth, comparing the result from this question to that from the previous one, it is rather
clear to notice a paradoxical attitude between the trust in doctors as shown in the previous
questions and the instrumentalization of medical professionals presented in this one. This
attitude has also been documented in other researches (Wiszmeg et al., 2012). On one hand,
most respondents acknowledge that doctors possess certain medical knowledge that lay
people lack and need, on the other hand, doctors may not be the only group where such
knowledge can be obtained, other medical staff within the system such as nurses and
pharmacists can also provide healthcare advice and service. One can even argue that doctors’
professionalism and authority are somehow commoditized through patients’ actively
seeking and synthesizing medical knowledge from different sources.
8. Have you had friends or relatives living outside Sweden sending medicines to you? If yes,
can you please describe?
Comparing comments on this question to those on the previous one, it is interesting to see,
although some respondents think it is necessary to have professional opinions, they seek out
certain medicines on their own from other countries. These medicines mentioned in the
comments include bio-medicines, such as sleeping pills, antibiotics, pain killers, bio-identical
progesterone and vitamin pills, and herbal medicines, such as cannabis oil and Chinese
medicines. Countries where these medicines are sourced include Thailand, China, the
Philippines and EU countries (UK and Scandinavia). One in four of these respondents have
Reasons given by respondents who get medicines sent from abroad include: cheaper and
more effective than medicines in Sweden, no prescriptions required or impossible to find on
the Swedish market.
The above results align with the data given by MPA (2015). What draws the attention is the
route medicines take in the globalized environment. Internet mobilizes information at a
dramatically fast speed, which makes shopping medicines from informal online pharmacies a
problem that is easier to identify. But, the increasing mobility of people around the globe
Have you had friends or relatives living outside Sweden
sending medicines to you?
Yes No No answer
also partly leads to the travelling of medicines. Shopping from online pharmacies might be a
dangerous thing for many respondents as shown in this survey, but getting medicines from
the family or close friends who live elsewhere, even it is strictly regulated in Sweden, does
not sound so intimidating. Another important finding from these comments in this specific
question is the absence of doctors or medical staff, that is to say, doctors are not always
invited in consumers’ decision making process. This could cause potential harm when it
comes to the consumption of prescribed medicines, even medicines in general.
9. Do you normally bring medicines with you when travelling abroad? Are they prescribed
medicines or Over-The-Counter (OTC) medicines? What kinds of medicines are they?
Results show that a majority of respondents take medicines with them during the trips.
Besides maintaining a healthy body, medicines’ social use is unveiled. For people who have
chronicle diseases or are prone to sickness, medicines are “domesticated” as a daily routine
to keep a normal life. They also are empowered by acting as a basic protection or some sort
of insurance to make sure the body does not fail and affect the journey. What’s more, the
preparation of medicines for a trip indicates a split between the “known” body in the
current familiar situation and the “unknown” body in the then foreign environment. In other
words, people speculate how the body would react during the trip. In this sense, medicines
do not only manage sickness, but also are used as precautions to control the body and
10. What do you do when you are sick and in need of medicines when travelling abroad?
A larger percentage of respondents choose to visit local pharmacies for not so serious
sicknesses, and doctors and hospitals for more serious ones. Many say they can manage
with their own medicines brought from home. To compare the way people approach
medicines when they are home to when they are not, the patterns show similarities.
Ranking/self-evaluating the sickness first, and then they decide whether to see a doctor or
go to a pharmacy. But, what differentiates the two scenarios is the availability of information
and resources one can get. Instead of comparatively easier accessibility to medical
assistance online and offline at home, people are to certain degrees left on their own to
figure out where and how to get help. Experienced travellers, travellers with small children,
travellers in a country where language communication does not work effectively, or
Do you normally bring medicines with you when
Yes No No answer
travellers with insufficient travelling insurance may behave very differently. In this sense, it
is worth segmenting travellers into different categories and study them separately.
11. Have you purchased prescribed medicines when travelling abroad? If yes, where did
you buy them? Please name the country and describe the situation briefly.
In situations where respondents have purchased prescribed medicines in foreign countries,
they follow normal routines as they do in Sweden, getting the doctors’ remiss before buying
the medicines either from pharmacies or at the hospital. But due to different pharmaceutical
regulations, prescribed medicines in Sweden may be sold as over-the-counters in some
countries. It is interesting to see some respondents are well aware of this and try different
strategies to minimize the risks of consuming “wrong” medicines by comparing the
ingredients written on the packages or buying medicines they have used before.
One comment draws particular attention where the respondent describes a personal
experience in Tanzania: “Tanzania. Four different kinds of antibiotics. Killed all the bacteria in
my stomach, so now I become ill by even the weakest virus.” It is difficult to tell if those
antibiotics were prescribed by a qualified local doctor or purchased by the respondent
oneself without consultation. What it indicates, however, is a lack of medical support for
individual travellers who are probably unfamiliar with local environments and do not
possess sufficient resources to get medicines that work just right to their bodies. Medical
tools that serve this purpose are needed to equip this kind of travellers.
Have you purchased prescribed medicines when
12. If you were/are affected by a serious disease against which there were/are no effective
medicines, for example, neurological diseases such as Parkinson’s disease or Huntington’s
disease, would you consider purchasing treatments and/or medicines which were
seemingly promising but not scientifically proven yet?
A typical explanation from those who would try such treatments and medicines is “One has
nothing to lose, so why not.” But there is also distrust of the system, not necessarily of the
Swedish healthcare system, but of the interrelated medical environment constructed of
political, financial and ethical conflicts. One respondent puts this strongly: “Coco oil has been
found as effective at least for Parkinson. But it’s not in pharmaceutical companies’ interest to
research this, so no such knowledge is developed. Diet studies are too costly and no one
wants to invest on things that can’t be patented later… Then, being scientifically proved does
not mean much, when one has read books such as Forskningsfusket by Sundberg or Deadly
Medicines and Organized Crimes by Gøtzsche.”
Among limited comments left by respondents answering no, confidence is shown towards
medical innovation in Sweden, which encourages them to stay in the Swedish healthcare
Regarding the large number of those who cannot decide what to do, it might be because
respondents think it is difficult to put oneself in a situation that is unlikely to happen to them.
What may also lead to this indecisive answer is the lack of sufficient knowledge to weigh the
pros and cons. Some respondents admit that they would perhaps eventually consider
purchasing treatments or medicines elsewhere, but not without careful examinations and
13. In which situations/scenarios would you consider seeking for treatments or medicines
that are neither legally approved in Sweden nor scientifically proven? Would you consider
doing so in Sweden, other countries or via Internet?
This is a difficult question, said many respondents. Apart from a small number of them who
firmly believe they would never “transgress”, most respondents did manage to present a
scenario where they would seek alternative treatments and medicines elsewhere, although
illegitimate or scientifically unproven. Similar to some comments on the previous question,
Yes No I don't know No answer
this action is often seem as “the last straw” or out of desperateness, the latter of which
draws particular interest. “Desperation” as an emotional performance is conceived as
irrationality. But the question is: are those people who choose to buy such kind of
treatments or medicines making irrational decisions? How do they legitimatize their health-
seeking choices? And how do we, as outsiders, make sense of it?
On the other side, there are people who argue that certain treatments or medicines are not
proved in Sweden does not necessarily mean they are illegal or ineffective. If people cannot
get help from the Swedish healthcare, then as long as the treatment where it conducts
proves effective, they would consider buying it. However, one bottom line mentioned by
one respondent is that it does not hurt other people, such as buying an organ. (“However I
hope that I would not hurt other people through my treatment, like, there are risks if one
The result here shows that, in the pursuit of health, transgressions are likely to happen.
People’s border-crossings may pose challenges to national healthcare system, and expose
the public to the potential danger of falsified medicines. However, patients’ illness
experiences and their hope for a healthy body must be considered to understand those
transgressions (Petersen, Hagen, Torkelson & Lundin, 2016).
14. Have you ever questioned the quality and efficacy of the medicines you have purchased?
If yes, when and how. Did you discuss your concerns with a medical professional?
Almost all suspicions are against medicines bought from abroad. Causes include either they
are too effective or they take no effect at all. Consumers therefore question the dosage of
ingredients. Another kind of suspicion results from that doctors prescribe antibiotics too
soon without much examination of the sickness. Only two respondents out of 25 who have
questioned their medicines say they have discussed the issue with their doctors back in
Sweden, but they end up with no response. Among the remaining 23 respondents in this
group, most of them simply discard the medicines and no discussions with doctors at all.
This is exactly the situation concerned by many researchers that no one suspects, no one
tells and no evidence is kept, which makes the problem of falsified medicines hard to tackle
(Liu & Lundin, 2016).
Have you ever questioned the quality and efficacy of the
medicines you have purchased?
Yes No No answer
However, one respondent points out that it is difficult for people without professional
training to tell the quality of medicines. This raises a need to equip the public with adequate
Insights from the results
Statistical results are aligned to those presented by MPA (2015). But open questions in this
survey encourage people to express their opinions freely. Although qualitative data is limited
in this pilot study, some insights still stand out.
1) The symbol that indicates an authorised online pharmacy is not recognized by at
least 2/3 of the respondents. Apart from letting people know about this symbol,
what is more important is perhaps a thorough understanding of people’s online
medicine shopping patterns, such as how the public conceive what qualifies an
online pharmacy and how they navigate through different websites and eventually
locate the one they have trust in.
2) Low acceptance of shopping prescribed medicines online is identified among the
respondents. What is worth further attention is that the movement of people may
also contribute, unknowingly, to the movement of falsified or substandard
medicines. This applies in two directions: when the Swedish public travel abroad and
when immigrants travel back and forth between their home countries and Sweden.
In the former case, tourists may be given unsuitable treatment or medicines by
foreign doctors who are not familiar with patients’ medical history, or tourists obtain
their medicines via informal channels in a foreign environment. In the latter case,
given the opportunities and advantages to get healthcare assistance in two
countries, immigrants’ trust in either health culture may encourage them to go
beyond the legal zone and put themselves in a “grey” position by playing with the
regulation gap among different nations.
3) Doctors and other medical professionals in general tend to be instrumentalized by
medical consumers. Their opinions and professional advices are synthesized by
individual consumers and accustomed to people’s own situations. This indicates that
doctors may have not participated in patients’ decision-making processes as much
as they should have, which can lead to difficulties in guiding people on shopping and
4) Question 12 and 13 in the survey put respondents in some extreme health-
threatening scenarios in order to see how they would respond. Results indicate that
a large number of respondents, when affected by deadly diseases, such as
Huntington’s, and after exhausting all possible treatments at the home country,
would consider going abroad to grasp any opportunities. This might expose them to
the risks of medicines from unknown or illegal sources. The results also demonstrate
that, in the globalized world, this historically-rooted pursuit of health, intertwined
with individuals’ entrepreneurship, takes on new forms. It then requires researchers
and healthcare professionals to find out an effective communication model to
provide sufficient information to protect these vulnerable patients from the danger
of unsuitable treatment and falsified medicines. It would also be sensible to consider
this insight with other working papers from the project Treatments of the Future.
5) Further studies are needed to study how people create value out of the national
healthcare service and how doctors and other medical professionals can play a role
in assisting in the public’s decision making processes.
6) This pilot study calls for a need to delineate the mechanism of selling and buying
falsified medicines, in other words, we need to know who are participating and why
they engage in these activities. In order to thoroughly understand how this
mechanism functions, ethnography and other qualitative research methods are
Liu, R. & Lundin, S (2016). Falsified Medicines: Literature review. Working Papers in Medical
Humanities, 2(1), 2016: 1-25. URL:
Petersen, M., Hagen, N., Torkelson, E. & Lundin, S (2016). Clinical experiments for
Huntington's disease. Recommendations to medical researchers regarding how
to inform potential participants. Working Papers in Medical Humanities, 2(2), 2016:
1-33. URL: http://journals.lub.lu.se/index.php/medhum/article/view/15789
Postnord (2016). E-barometern Q1 2016.
The Swedish Medical Products Agency (2011). Läkemedelsverkets arbete för att
motverka olagliga läkemedel. URL: https://lakemedelsverket.se/upload/om-
The Swedish Medical Products Agency (2015). Köp av receptbelagda läkemedel från
osäkra källor på internet - En Enkätundersökning. URL:
Wiszmeg, A., Lundin, S., Torkelson, E., Hagen, N., & Lundberg, C. (2012). Difficult Questions
and Ambivalent Answers on Genetic Testing. Culture Unbound, 4, 2012: 463-480.