1. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  2. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2020 »
    Dismiss Notice
  3. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
  4. Guest, stay home, stay safe, save the NHS. Stay up to date with information about keeping yourself and people around you safe here and GOV.UK: Coronavirus (COVID-19). Think you have symptoms? NHS 111 service is available here.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

From The Times today - Medication (General, but including Statins)

Discussion in 'Diabetes Discussions' started by AndBreathe, Dec 16, 2014.

  1. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
    Retired Moderator

    Messages:
    9,659
    Likes Received:
    15,719
    Trophy Points:
    178
    This was in today's Times. The link is here: http://www.thetimes.co.uk/tto/health/dr-mark-porter/article4298030.ece


    but for those unable to access it (The Times is by subscription in UK), here is a copy:

    ·
    Dr Mark Porter
    Chris McAndrew

    Dr Mark Porter

    Published at 12:01AM, December 16 2014

    ‘Medical creep’ — or medicalising what was once normal — can save lives but isn’t always the best route to good health


    Primum non nocere — first do no harm — is an ancient cornerstone of medical practice but there is growing unease that modern medicine has abandoned this basic principle in its quest to battle disease. And that unease can only have been exacerbated by the latest figures from the Health Survey for England revealing that about half the population is now on some form of medication and that more than a fifth are taking at least three different drugs.


    There have been considerable advances in the time that I have been a doctor, many of them as a direct result of prescribing more medication. When I was born, in the Sixties, 200,000 British men and women died every year from heart attacks. Today that figure has more than halved thanks in part to better preventive care and more aggressive therapies.


    My grandfather had a fatal heart attack at the age of 67 in 1972. He avoided doctors wherever possible and I doubt he knew what his blood pressure and cholesterol level were. And when he was admitted to hospital with chest pain he wasn’t treated with anything other than bed rest, only relieved by trips to the ward day room for a smoke. Little wonder that fewer than two thirds of patients survived the experience.


    Today we throw the kitchen sink at people like my grandfather and survival is now the norm rather than the exception. There have been similar advances in treating other major killers such as stroke and cancer too. The modern mantra that prevention is better than cure, meanwhile, has resulted in a shift away from focusing on the poorly individual to identifying whole populations who are currently well but at higher than average risk of trouble in the future.


    Most people over 50 are now eligible for cholesterol-lowering statins and at least one in five of the population has blood pressure high enough to warrant treatment (often with two to three separate drugs). Between them these two conditions mean that at least 10 million adults take more than one pill every day, and that is before you consider what they might be taking for a host of other ailments endemic in our modern society, from asthma and arthritis to diabetes and dyspepsia.


    There are lots of factors behind the explosion in prescribing, including “medical creep”, the medicalisation of what was previously regarded as normal, a process often driven by people with a vested interest, such as pharmaceutical companies. Then we have targets and incentives given to doctors for identifying and treating problems such as high blood pressure and raised cholesterol levels and there is patient pressure to be prescribed the latest headline-grabbing elixir of life.


    Although the net effect is beneficial — putting 10 million people on statins will save lives — some are bound to be harmed. And herein lies the biggest challenge for the prescriber. Clinical trials may show that prescribing more statins, blood pressure medication, blood thinners and osteoporosis treatments will improve quality of life for some, but they will do nothing for many and harm a few. Unfortunately it is almost impossible to know in which group you are likely to fall. So how lucky do you feel?

    Here are five questions I think every patient should consider if they are on medication, or being offered it:

    How likely is it that my pills will protect me?
    Doctors are very aware that most patients on preventive medicines don’t gain as much as they like to think. Take statins. Used appropriately they can delay your first heart attack or stroke, but by nowhere near as much as most people imagine: 67 people have to take a statin for 5 years to prevent one of them having a stroke, while 100 have to take the drug to prevent 1 heart attack over the same period. Meanwhile as many as 1 in 10 of those same people will be harmed in some way by side effects that range from mild muscle aches (common) to life-threatening kidney failure (very rare). These figures are known as “numbers needed to treat” (NNT) and you can look up the NNT for the treatment you are being offered under the therapy reviews section of thennt.com

    Will a new drug interact with medicines I am already taking?
    This should be a job for your doctor or pharmacist but mistakes are common and it always pays to ask. They may not always know. As people take more and more medicines it can be harder to predict how they might interact — drug trials often don’t test safety in the real world where poly-pharmacy is common and worrying interactions can take years to come to light. So it should come as no surprise that in today’s NHS, where 2.5 million medicines are prescribed every day, adverse drug reactions now account for 6.5 per cent of acute hospital admissions across the UK.

    Am I allergic to this?
    Again, your doctor of pharmacist should know, but don’t depend on it being flagged up in your notes. Know what you are allergic to and tell everyone who prescribes for you each time they offer you a new medicine. Allergic reactions, such as those to commonly used antibiotics, account for 1 in 30 drug reactions reported to the National Patient Safety Agency — and those were in people with known allergies who should never have been taking the drug in the first place.

    Am I taking my medicine properly?
    It may seem a daft question but the World Health Organisation estimates that as much as half of all long-term medication is not taken regularly enough to be effective. It’s not only preventive medication like statins: poor “compliance” is an issue in conditions that cause troubling day-to-day symptoms too. The Medicines Partnership estimates that half the five million people on treatment for cough and wheeze caused by asthma are not using their inhalers properly and that the younger the patient, the bigger the problem. If you don’t take your medicines properly, you risk getting none of the benefit but paradoxically may end up with the same side effects. You have swung the benefit/risk ratio firmly in favour of risk.

    How can I help myself?
    This is the most important question of all, but one that surprisingly few people ask. If you expect your medicine to be an alternative to making lifestyle changes — such as stopping smoking, losing weight, eating well and exercising — then you are likely to be disappointed. Many medicines can help you in ways that lifestyle changes cannot, but when it comes to disease prevention in areas like stroke, heart attack and many cancers, few if any are as effective as self-help. Take heart attacks and statins. If you are deemed to be at higher than normal risk of an early attack then, according to data on thennt.com, switching to a Mediterranean diet is likely to work just as well as taking a statin — and without the side effects.


    I am not advocating that you avoid medication that you might need. Quite the opposite. However, along with many of my colleagues I think we should question our growing dependence on pills. Doctor doesn’t always know best and a pill isn’t always the solution — at least not the only one.

    Pill-popping in the UK

    • 2.5 million prescriptions are issued every day across the NHS

    • 14 per cent (1 in 7) of the adult population in the UK take a cholesterol-lowering statin and a similar proportion take one or more drugs for high blood pressure

    • The omeprazole family of antacids are the next most commonly prescribed type of medication (9 per cent of adults), closely followed by painkillers and anti-inflammatories

    • 1 in 20 men and 1 in 10 women are taking antidepressants

    • In any week as many as 1 in 50 of the population are on antibiotics

    I'm not posting this to make any particular point, it's just potentially a conversation point.
     
    • Like Like x 7
  2. sanguine

    sanguine Type 2 · Well-Known Member

    Messages:
    3,341
    Likes Received:
    9,636
    Trophy Points:
    178
    Interesting and thanks for posting. I looked up the Hippocratic Oath the other day and noticed the 'do no harm' or its equivalent. Through carelessness or following the money that seems to have taken a back seat with respect to statins at least.

    More and more we have to be proactive. My wife knows of several cases where GPs have prescribed something without even looking up what else the patient is on, let alone knowing if there is any potential conflict. Often it it the pharmacist in Boots who notices and says "you can't take this if you're already on that".

    The impression is that we are now a society where health care is subservient to drug dependency, both on the part of patients and on the manufacturers and prescribers of those drugs. It's quick, it's profitable and in the majority of cases the rationale and wisdom are left unquestioned.
     
    • Like Like x 6
  3. caliban

    caliban Prediabetes · Active Member

    Messages:
    33
    Likes Received:
    55
    Trophy Points:
    58
    I was prescribed 90mg of Lipitor after an acute cardiac event. I then started to get severe back pain and was unable to walk for more than a few hundred yards or stand for any length of time. I did'nt associate this with the drug until I was in hospital and met a guy who had the same problem and had done some research and had stopped taking it. Within 2 months his pain started to subside and was at that time pain free. I stopped taking it and am now pain free and can walk 6 miles without any problem. I also suffered cramps at night and nightmares which can be other side effects. I control my cholesterol through a low carb diet. All the patient studies are done by the drug companies and are confidential. They are making billions out of this mass prescription. My Doctor still tries to force me into taking these drugs but I'd sooner have a shorter life without pain, it's all about quality of life not quantity, for me anyway.
     
    • Like Like x 2
  4. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

    Messages:
    23,618
    Likes Received:
    19,614
    Trophy Points:
    278
    There's nothing new in that article that hasn't been discussed on here or in other newspaper articles, prevention is desirable and that is why many are prescribed bp and cholesterol meds or ask to go on them, but prescribing drugs like statins should be on individual need and not be handed out like sweets without just cause.
     
    • Like Like x 2
  5. zand

    zand Type 2 · Expert

    Messages:
    9,395
    Likes Received:
    15,614
    Trophy Points:
    198
    It may not be new, but I was interested in Dr Porter's views. Thank you @AndBreathe
     
    • Like Like x 3
  6. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
    Retired Moderator

    Messages:
    9,659
    Likes Received:
    15,719
    Trophy Points:
    178
    I didn't consider there is anything new or ground-breaking in the article, but comforting to see a practising GP who counsels lifestyle, moderation and caution, as opposed to drugs, as a first port of call.
     
    • Like Like x 5
  7. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

    Messages:
    23,618
    Likes Received:
    19,614
    Trophy Points:
    278

    I'm all for gp's like that Andbreath, lifestyle changes should always be the first option if appropriate :)
     
    • Like Like x 3
  8. zand

    zand Type 2 · Expert

    Messages:
    9,395
    Likes Received:
    15,614
    Trophy Points:
    198
    Yes I agree, it would be nice to be pointed in the right direction with these as well, i.e. not simply be told 'lose weight', but to be given good advice on how to do that would be wonderful. :)
     
  9. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

    Messages:
    23,618
    Likes Received:
    19,614
    Trophy Points:
    278

    Pleased we agree with something then ;)
     
    • Like Like x 2
  10. zand

    zand Type 2 · Expert

    Messages:
    9,395
    Likes Received:
    15,614
    Trophy Points:
    198
    I think that's maybe the 3rd time? lol :)
     
  11. izzzi

    izzzi Type 2 · Well-Known Member

    Messages:
    4,207
    Likes Received:
    2,400
    Trophy Points:
    178
    Thanks @AndBreathe good post.
    My question would be, will these pills help me live longer. being that we live longer these days thanks to some pills.
    I did not get your comment "Today we throw the kitchen sink at people" (you need help) did make me smile though.
    I am not a fan for taking pills. However if I was told you need a medicated pill for health reasons I would do my homework first.
    Dr M Porter also made a interesting remark regarding health "Searching for health information has ranked as one of the most common reasons for surfing the internet" just beware the quacks.
     
  12. AlexMBrennan

    AlexMBrennan Type 1 · Well-Known Member

    Messages:
    385
    Likes Received:
    298
    Trophy Points:
    103
    I'm sure there'd be a nobel price in it for you if you could share how you are going to identify the one person out of 100 who will not have a heart attack as a result of the statins.
    But yeah, if you feel that a life is worth less than the cost of 100 people taking statins for five years then go ahead and stop prescribing... but do be aware that you are killing 100 000 people every five years (14% of 60 million taking them, with one life being saved per 500 patient years)
     
  13. sanguine

    sanguine Type 2 · Well-Known Member

    Messages:
    3,341
    Likes Received:
    9,636
    Trophy Points:
    178
    I'm sure you know that's not how the stats work. Even if you believe that high cholesterol significantly increases heart disease risk, there are other non-pill-popping ways to reduce cholesterol. Individuals can do more than statins to make the possibility of them becoming that 1 in 100 far less likely.

    And what about the 99 people who may have their lives shortened or quality of life diminished by unnecessary statin side-effects?
     
  14. douglas99

    douglas99 I reversed my Type 2 · Well-Known Member

    Messages:
    4,572
    Likes Received:
    3,763
    Trophy Points:
    178
    I wonder how many people on here take omeprazole, or another proton pump inhibitor, as mentioned in the article.
     
  15. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
    Retired Moderator

    Messages:
    9,659
    Likes Received:
    15,719
    Trophy Points:
    178
    I didn't make the comment you refer to.
     
  16. izzzi

    izzzi Type 2 · Well-Known Member

    Messages:
    4,207
    Likes Received:
    2,400
    Trophy Points:
    178
    Sorry, must be some kind of Welsh humor. ( never herd it before ):)
     
  17. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

    Messages:
    24,891
    Likes Received:
    30,455
    Trophy Points:
    298
    Thank you for posting this @AndBreathe. I found it very interesting. I wish my GP would have a proper look at my significantly improved lipids and cholesterol through diet alone, and let others have a try before prescribing statins (that she continues to push at me)
     
  18. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

    Messages:
    23,618
    Likes Received:
    19,614
    Trophy Points:
    278
    Undoubtedly they do izzi, as Dr Porter acknowledges in the article:

    There have been considerable advances in the time that I have been a doctor, many of them as a direct result of prescribing more medication. When I was born, in the Sixties, 200,000 British men and women died every year from heart attacks. Today that figure has more than halved thanks in part to better preventive care and more aggressive therapies
     
  19. Brunneria

    Brunneria Other · Moderator
    Staff Member

    Messages:
    20,603
    Likes Received:
    34,229
    Trophy Points:
    298
    I know several people who have had adverse drug reactions (some people seem to experience this repeatedly), but 6.5% of all acute hosp admissions is horrifyingly high.

    And (presumably) for every case bad enough for hospitalisation, there are many more that are not so severe.

    The cost of this alone must impact the NHS coffers significantly.

    Thank you @AndBreathe
     
  20. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
    Retired Moderator

    Messages:
    9,659
    Likes Received:
    15,719
    Trophy Points:
    178
    There was also an item on Bulletproof Coffee.
     
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook