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