How do we wean doctors (and the nation) off of drugs?

A PROFESSION ADDICTED TO DRUGS?

It should come as no surprise, as in every other walk of life, scientific research and its findings, can be influenced by factors other than what is good for the patient! Doctors are addicted to drugs: sometimes for themselves but mainly for their patients. The economic success and profitability of pharmaceutical companies depends not on the health of the nation but on an increase in ill-heath and a multiplicity of diseases, for which ever more 'miracle' drugs are required. 

We have to trust that prescribing is done in good faith and in the belief that it is in the best interests of the patient. In short, to use a phrase made popular in the Covid debacle, just "following the science". Unfortunately life is not quite that simple or straightforward. The financial performance of the pharmaceutical company may weigh more in the board room.

DRUG PUSHERS?

Doctors, and increasingly pharmacists, are the essential key to the chemical company profits. Many preparations can be obtained 'over the counter' but the more important and lucrative ones must be prescribed. This is why drug companies have historically paid great attention to GPs and other doctors, showering them with benefits in kind. 

GP's in particular are subject to a 'pincer movement' of pressure from the companies that make the drugs with their often exaggerated claims and from the patient himself, seeking a cure from whatever condition he or she is suffering from. This creates a triangulation of interests, expectations and financial benefits that may in fact be illusionary and harmful. 

PSYCHOLOGICAL DEPENDANCY?

The very idea of miracle pills and miracle medicine, blinds both patient and doctor to underlying causes, probably harder to address. In a situation where there is no cost implication to either prescriber or recipient - directly at least, because the cost is borne by the state and paid for out of general taxation -  no disincentive operates. 

This rather obviously, has both positive and negative consequences. Treatments are not circumscribed by the patient's ability to pay but nor is there any reason to question whether the drug is either cost-effective or even necessary.

GOVERNMENT RESERVATIONS

It would appear the government may be coming to the same opinion. England's most senior doctor, Prof. Sir Stephen Powis, NHS medical director, has recently stated that doctors must stop "doling out a pill for every ill, as it leaves millions of patients hooked on drugs they do not need."

He continued, "Figures suggest around 10% of prescriptions are not needed." This equates to nearly £1 billion to the national health!  Even this figure underestimates the real figure, as it excludes the cost to individuals, either as their statutory contribution or that spent on drugs not requiring a prescription. Nor does it include the huge saving that would flow from healthier life styles, particularly as it relates to diet, exercise and obesity.

DRUG INDUCED ILLNESS

During 2021, 1.14 billion prescription items were dispensed by pharmacists in England - a 3 per cent rise on the previous year!  More than eight million people take more than five pills per day. The total number taking chemical substances of one sort or another, either legal or illegal, is obviously much higher. Much of the NHS effort and budget is taken up dealing with the adverse effects of these with many thousands ending up in hospital as a direct result. Iatrogenic disease (i.e. conditions caused by medical interventions) constitute up to a fifth of hospital bed occupancy.

Among the European Union Member states, WHO concluded that the healthcare-related errors occur in 8% to 12% of hospitalizations. A report named “organisation of memory” estimated 850,000 adverse drug reactions (ADRs) occur in hospital each year.  This figure does not include hospitalisations that result from reactions to chemicals taken or prescribed in the community, so those figures must understate the problem. Over one in five hospital admissions for the over 65's, result from adverse effects of medications costing the NHS at least £2 billion. A third of over 80's take eight or more medicines daily!

A DRUG FOR EVERY ILL

Let us look at just some of the categories of over-use and over-prescription by category, taken from government sources:

Anti-biotics

"Overall prescribing rates were 659, 654 and 607 per 1000 registered patients for 2013, 2014 and 2015, respectively. 27 Feb 2018".

Discovered by Fleming just before World War II, anti-biotics have undoubtedly saved millions of lives. However the dangers of over-prescribing them for conditions against which they were ineffective, such as viral colds, are well known. Misuse of these wonder drugs both in animals (to off-set battery conditions and aid growth) and in humans has allowed germs to develop resistance to them. Increasingly common anti-biotics are ineffective against bacterial infections. This could be catastrophic in a real pandemic which clearly Covid was not. Doctors are eventually reacting to this fact and prescribing less but the damage has already been done.

Anti-depressants

"Between April to June 2021, 20.5 million anti-depressant drugs were prescribed. This is a 2% increase from 20.2 million items in the previous quarter, and a 7% increase from 19.2 million items for the same quarter in 2020/21."  

In other words over 80 million prescriptions in an adult population (over 18) of 54 million and on the increase year on year! Clearly a lot of people are diagnosed as suffering from depression. It points to a fundamental flaw in the nature of society, relationships and the human psyche. 

But leaving that aside there is a big question mark over whether the popular anti-depressants work or at least work as well as their manufacturers claim. They may even have the opposite effect and make both depression and suicide more likely. The disastrous long-term addictive consequences of Benzodiazepines such as 'Librium',  'Valium' and many other proprietary names, known sweetly as 'Mummy's little helpers', are well known but it seems lessons have not been learned. 

Practical measures to tackle the problem of depression which seems to be rife, such as changing life and work circumstances, talking therapies, friends, social activities, pets, exercise, diet and sleep, may be far more effective, but getting doctors to pursue these is still not generally applied. A pill seems to be a far more convenient option.

Dementia

"997,000 drugs for dementia prescribed, a 2% increase from 982,000 items in the previous quarter.  The total cost of care for people living with dementia is typically £100,000, but can cost as much as £500,000. The cost of dementia to the UK is currently £34.7 billion a year, which works out as an average annual cost of £32,250 per person with dementia."

Mental decline is a likely consequences of aging but is not inevitable.  Weakness of body does not necessarily entail weakness of mind. However the larger the proportion of older people in the population, the more prevalent it is likely to become. Once dementia sets in, the prospects are not good and it is understandable that doctors faced with it, will grasp at straws, as will the sufferers, as the above statistics prove. 

But no one is really sure whether the cholinesterase inhibitors used  (Donepezil (Aricept), Galantamine (Razadyne) and Rivastigmine (Exelon) are the most commonly used) are ultimately beneficial at slowing decline, improving memory or reducing associated psychosis. In large part they are still experimental. They certainly have significant adverse side effects across a range of psycho-motor areas. Sufferers are often persuaded ill advisedly, as to their efficacy, putting up with deterioration or pain in other areas as the necessary cost.

How much the misleading claims of drug companies raise unfounded expectations in doctors and patients is undetermined, but again no one really knows whether the huge cost to the NHS is really beneficial or effective.

Diabetes

"In 2020/21, there were 57.9 million drugs used in treating diabetes prescribed in England for a cost of £1.19 billion, 12.5% of the total spend on all prescription items prescribed in England. Some 7% of the UK population (4.9 million) are now living with diabetes; approximately one million people have undiagnosed type 2 diabetes, 40 000 children have diabetes and more than 3000 children are diagnosed every year."

The discovery of insulin and the role of the pancreas in the disease of diabetes  were life savers for the many struck with the condition. The effective treatment did not stop the trend of increasing in the numbers suffering from it. The pre-disposing features are well known. They include family and genetic factors, but obesity and diet are hugely significant. Britain has changed its eating habits over the last fifty years towards fast foods and an essentially American-style diet, which also has a distinctive disease pattern. The average body shape has changed as a consequence and lower socio-economic groups are proportionately worse affected. Now "63% of UK adults (aged 18+) are overweight or obese (2018/19). This equates to an estimated 35 million overweight or obese UK adults."  

It is clearly not in the interests of the fast food industry or the pharmaceutical industry to reduce diabetes, but it is in the interests of the public and government. The increase in diabetes has the potential to bankrupt the NHS and nation if not tackled. The question is whether doctors help or hinder that process?

Sleeping pills

"Last year, 15.3 million NHS prescriptions were made for sleep medication. Patients in England alone received 5.4m prescriptions for zopiclone and 2.8m for temazepam, the two most popular sleeping pills."

It is generally acknowledged that sleep, for all its biological mystery, is essential for both mental and physical health. It is a phenomenon common to virtually all species and so must be hard wired into the human biological make-up. The requirement for sleep varies between individuals (Mrs Thatcher was famously said to require only four hours a night) but the fact that so many prescriptions are required indicates a major problem of people not being able to get to sleep without chemical assistance.

What effort is made by doctors and patients to identify causes and try alternative remedies before resorting to drugs with potentially serious adverse health consequences?  I suspect very little.

Heart conditions

"On average, patients with heart failure take 6.8 prescription medications per day, resulting in 10.1 doses per day, not including over-the-counter (OTC) or complementary and alternative medications. (12 Apr 2017)   Around 920,000 people in the UK today have been diagnosed with heart failure. Both the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77.12 Sept 2018 Statins are one of the most commonly prescribed drugs in the UK: around 7-8 million adults in the UK take them, and over 71 million prescription items were dispensed in 2018."

We may conclude from the disparity between the number of people diagnosed with a heart condition and the number of Statin prescriptions, that these drugs are widely prescribed by doctors as a preventive measure as well as a treatment for high cholesterol and heart conditions. The problem is that the whole regime based on, and promoted by, drug companies, that saturated fat consumption leads to high cholesterol and that this in turn leads to ischaemic heart disease and strokes, is wholly misplaced and misguided. It has spawned huge profits for the manufactures but also created a whole range of medical disorders unnecessarily. 

As Dr David Diamond and others have conclusively demonstrated, the association is largely illusionary, as is the claimed benefit for Statins in the prevention of these conditions (around one percent not the forty or fifty per cent claimed) and is by far off-set by their adverse consequences. As he has shown, it is not saturated fats but excess carbohydrates and sugars that predominantly cause the problem, although of course other related factors are involved. 

Statins have made billions for drug companies around the world but particularly in Europe and North America, based it would seem on a convenient (for them) misnomer. Yet again doctors are the active participants and facilitators in a costly scam!

Pain relief

"PHE’s analysis shows that, in 2017 to 2018, 11.5 million adults in England (26% of the adult population) received, and had dispensed, one or more prescriptions for any of the medicines within the scope of the review. The totals for each medicine were:

antidepressants 7.3 million people (17% of the adult population)
opioid pain medicines 5.6 million (13%)
gabapentinoids 1.5 million (3%)
benzodiazepines 1.4 million (3%)
z-drugs 1.0 million (2%)

There are large variations in the standardised rates of prescribing across clinical commissioning groups (CCGs)."

It is over seventy years since George Orwell predicted the generalised application of 'Soma' to keep the general population placated and we are now well on our way to fulfilling it. The NHS has become an indispensable part of our 'Oceania' as became all too clear in the Covid debacle.

CONCLUSION

These statistics are truly startling.  It would seem, even leaving aside the recreational use of non prescription drugs and those not requiring a prescription, on average at least twenty prescriptions per person per year are made. Given the proportion not on medication of any kind, for those taking them, the figure must be much higher. The cost to the NHS and nation, both directly and in adverse effects, is truly staggering. 

For 2021 the figures were:

The cost of prescription items dispensed in the community in England was £9.61 billion, a 3.49% increase of £324 million from £9.28 billion in 2019/20.

The number of prescription items dispensed in the community in England was 1.11 billion, a 1.90% decrease of 21.5 million items from 1.13 billion in 2019/20.

Atorvastatin was the most dispensed drug in England in 2020/21 with 49.9 million items, while Apixaban was the drug with the highest cost of £356 million.

Sertraline 100mg tablets was the presentation with the largest absolute increase in cost between 2019/20 and 2020/21 of £78.9 million, from £21.0 million to £99.9 million. 

Government has been aware of the widespread, unnecessary and adverse effects of drugs for decades but has effectively promoted them with the active assistance of 'big pharma', the NHS and the medical profession. The situation is getting worse not better. Drastic action is required to reverse the trend. The survival of the NHS as well as the public's health depend on it.

WHAT IS THE ANSWER?

The question posed at the top of this article was, "How do we wean doctors and the nation off of drugs?  

First and foremost, both doctors currently prescribing them and patients demanding them must want to come off them. That is the psychological province of the will, of beliefs and attitudes conditioned by society at large and by the propaganda we call advertising. 

People must be properly and adequately educated about their bodies and how to keep them working healthily. It is a task that starts in the home, continues in school and hopefully continues thereafter. Much illness and disease is preventable but there will always be instances that are not and that will benefit from chemical interventions. A clear separation between the two is essential.

The relationship between drug companies, government, the NHS and the medical profession needs to be tightly controlled to prevent undue influence or conflict of interest. Better use of proprietary brands and control of prices is needed to cut the overall cost. 'Free at the point of use' should be limited to true need.

Prevention is obviously better than cure, but clearly far more needs to be done in this sphere where there is a proven link between life style habits and resultant illness. Alcohol, diet, smoking and stress are obvious areas.

There needs to be far more open debate and freedom of expression surrounding the claimed advantages of certain drugs and procedures, or of underlying medical givens.  The role of cholesterol in the incidence of  heart disease and the effectiveness of statins in their prevention is an obvious one. The necessity and effectiveness of vaccination regimes is another. The widespread use of drugs in mental decline is another. The prescription of pain killers in place of osteopathy (not available on the NHS) is another.

Sickness can be as much a social condition as a physical one. Financial and other incentives and disincentives need to be considered. The system should be so organised to be able to address causes rather than just treating the symptoms.

Covid highlighted the weaknesses in the GP service that have continued since. Patients have faced multiple barriers to seeing the doctor. This may have accounted for the reduction in prescriptions referenced above.  However the nature and purpose of the interaction needs to change, so that it is less of a drug prescribing service, to one that promotes natural and obvious remedies. These could be provided at a fraction of the cost for much greater savings long term. GP payments should be more closely tied to performance an outcomes rather than just numbers on a list.

Medicine likes to think of itself as a science. It also requires a high level of practical skill. But somewhere along the line the social and environmental inputs have been given less attention. Health after is largely a reflection of these. Drugs and vaccines have too long been regarded as 'magic bullets'. Somehow we need to break the spell if the problem of drug dependence and its multiplicity of adverse consequences is to be addressed.

CASE STUDIES

Only yesterday I sat on a bench with a woman in her late thirties I suppose (it is considered rude to ask a woman her age!) who said she had been very ill for a year with a range of symptoms including brain seizures. This she said had finally been put down to a drug wrongly prescribed and finally changed. She did not say what condition the drug was prescribed for, but claimed it had ruined her heart, for which she now had to take other medications. She did not 'look' well. A taxi arrived to take her and her shopping home. She said she spent most of her time in bed too poorly to do anything. Of course this is too unspecific to be much use but how representative is it of the general population and a much bigger problem?

A more reliable example is as follows. A seventy year old man suffered severe chest pains, diagnosed at the local hospital as a serious heart attack for which emergency admission and Primary Percutaneous Coronary Intervention (PPCI), also known as angioplasty or coronary angioplasty was applied.  A blockage or clot  located in the left coronary artery was dispersed and two metal stents implanted to restore normal blood supply, notwithstanding the damaged caused to the heart muscle. Subsequently four days were spent recuperating in the cardiac unit. Further procedures were proposed but declined.

Now as to standard drug regime in such cases, the following drugs were prescribed, to be taken on a permanent daily basis thereafter:

 

Iatrogenesis: A review on nature, extent, and distribution of healthcare hazards Https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

https://www.nhsbsa.nhs.uk/statistical-collections/medicines-used-mental-health-england/medicines-used-mental-health-england-quarterly-summary-statistics-april-june-2021#:~:text=Key%20findings&text=20.5%20million%20antidepressant%20drugs%20were,same%20quarter%20in%202020%2F21.

David Diamond on Deception in Cholesterol Research: Separating Truth From Profitable Fiction https://www.youtube.com/watch?v=inwfSkSGvQw&t=9s