Do we really need to be taking so many pills?

Too many pills blog image

Are you worried about the sheer number of different medications so many people – particularly the older members of your family – are taking on a daily basis?

There has been a staggering threefold increase in the number of prescriptions issued by GPs in the UK in the last fifteen years, with millions now committed to taking a cocktail of half a dozen (or more) different pills to lower blood pressure and blood sugar levels, statins to lower cholesterol, as well as drugs to strengthen bones, protect the heart and steroids to fight inflammatory diseases – and please don’t ask me about antibiotics and how their indiscriminate over-prescribing has fuelled digestive and gut disorders.

Just how did this ‘too many pills’ phenomenon arise?

Unfortunately, as with many things, financial gain is the answer to this question. Doctors are feeling the pressure to sell.

It was in my early career in banking, when I first experienced the pressure to ‘sell’.  I started my banking job at the age of 17, as a Junior and my duties involved making tea and coffee, sticking stamps on mail, taking mail to the Post Office (this was in the days before franking machines and couriers), ensuring the cashiers had all they needed in terms of stationery, nipping out to get the Manager’s lunch, and lots and lots of filing!

I worked my way up the ranks, and by the time I resigned, I was responsible for lending (personal loans, business loans and mortgages), and occasionally going ‘on the counter’ serving customers.

I’d been working in the bank for 13 years when the owners decided to put the business up for sale, eventually selling it to a much larger bank overseas. That’s when things began to change, for the worse!  

The Christmas bonus and annual profit-sharing scheme went out of the window and the staff was switched onto performance-related pay and expected to sell, sell, sell ‘products’, whether the customer wanted them or not.  If they didn’t reach their allocated targets, they were hauled before the Manager to explain why, and had to attend extra training to teach them how to ‘sell’ more effectively.

By way of example, if someone come into the bank to open an account, we were expected to ‘sell’ them a loan, a credit card, a will and all manner of other ‘products’.  This put staff under pressure; we got fed up, morale dropped, and customer service went out of the window – it’s little wonder banking has the reputation it does now.  I left the bank because that type of selling did not align with my values and I refused to sell ‘products’ to someone that didn’t need them, and probably could not afford to pay them back!  

I trained in complementary therapies and the rest is history. 

What has selling got to do with prescriptions?

Only last year, it was with surprise and shock that I learned about the Faustian deal done in 2004 between the BMA (British Medical Association) and its GP members and the then Government, where, for a 50% increase in salary, GPs were ‘encouraged’ (I use this word loosely) to get their patients onto more medications.

This new ‘deal’ was voted upon by the BMA’s members and accepted by 2/3 of them, thus the era of over-testing, over-medicalisation, over-prescribing and over-consumption of drugs came to be.

This has resulted in the situation we have now – a sharp increase in the number of emergency hospital admissions for serious side effects that have come about from this dramatic increase in polypharmacy (defined by the World Health Organisation as ‘the administration of many drugs at the same time or the administration of an excessive number of drugs’) and, for the first time in many years, a decline in life expectancy.

What does this change mean?

I’ve been a natural health practitioner for a long time, and had noticed, over the past 10 years at least, that more and more of our clinic patients were taking more drugs.  28 years ago, when I first went into practice, I would examine the health questionnaire that I asked everyone to complete prior to coming for treatment, in particular the ‘What medications are you currently taking?’ section, and there would be very few listed.  Now, it’s not uncommon to have 5 or more drugs listed. 

The risk of adverse drug reactions (ADRs) increases by 13% if you’re taking two drugs; it raises to 58% if you’re taking five drugs, and to 82% if you’re taking seven or more.

I want to believe that the BMA and government had the best intentions, and they genuinely believed that getting people onto more medications to reduce blood pressure and cholesterol levels would reduce hospital waiting lists, and save money in the long run.  The BMA ‘sold’ this arrangement to the government, stating that there would be a substantial health gain with an estimated 30,000 lives saved every year.  However, this has not been the case.  The number of referrals and admissions to hospitals should have fallen, but the opposite has happened, with an approximate increase of 5% each year. 

And, worryingly, I don’t remember seeing any posters or leaflets in my GP surgery outlining this new ‘arrangement’, do you?  Kept it very quiet, didn’t they?  Initially, there were 12 targets to prevent heart disease, 18 for diabetes, 5 for blood pressure and 8 for lung cancer.  Since then, this list has expanded considerably and now includes asthma, obesity, dementia and depression.

One example of the requirements of the ‘deal’ was every patient should have a BP of 150/90 or less, and a cholesterol reading of 5 or less, and if not they should be on medication. And so began the mass prescribing of statins and BP medications to millions of people whose measurements may only have been marginally above ‘normal’.  No advice about diet and lifestyle to reduce marginally high cholesterol and blood pressure – no, that takes far too long, and besides that doesn’t earn the surgery or the drug companies any money.  So you see, some GP surgeries are now run like a business, where the most important figures are those on the balance sheet.

Here’s a quote from Scilly Isles GP, Douglas Jeffries:

‘I am increasingly dismayed by the role that has been thrust upon us,’ he wrote in the British Medical Journal.  ‘It involves ruthlessly pursuing people who feel perfectly well where the finding of any one of a multitude of minor physiological or biochemical variations can lead to a lifetime of medication, repeated blood tests and other investigations and the adoption of a sickness role that diminishes the overall quality of life.  I prefer the idea of seeing patients who are actually ill rather than those whom epidemiologists and pharmaceutical companies believe to be in need of drug treatment.’

In 2016, the Government-sponsored a review and found no evidence that this mass medicalisation of the population has had any significant effect on emergency admissions or on the health of the population.  The significance of this conclusion is staggering.  It is a refutation of the doctrine that the whole population is ‘sick’ and therefore the whole population needs medicalising. The population was not ‘sick’, but the population has been made ‘sick’ by the over-medicalisation of their lives these past 16 years or so.

What is being done about it?

Will things go back to the way they were?  No, of course they won’t.  There’s too much money to be made.

In James Le Fanu’s book ‘Too Many Pills – How too much medicine is endangering our health and what we can do about it’, the author draws upon his experience as a GP to make his own stance on polypharmacy abundantly clear – it is, he says, undesirable ‘folly’ and the cause of much unnecessary misery.

Le Fanu states:

“There are some GPs who feel the current system is flawed and they have become nothing but peddlars of drugs.  A group of GPs drew up the following 10 Commandments:

  1. Thou shalt have no aim except to help patients according to the goals they wish to achieve.
  2. Thou shalt always seek knowledge of the benefits, harms and costs of treatments, and share this knowledge at all times.
  3. Thou shalt, if all else fails, or if the evidence is lacking, happily consider watchful waiting as an appropriate course of action.
  4. Thou shalt honour balanced sources of knowledge, and keep myself from all who seek to deceive thee.
  5. Thou shalt treat according to the level of risk and not to the level of risk factor.
  6. Thou shall not bow down to treatment targets designed by committees for these are but graven images.
  7. Honour thy older patients, for although they often have the highest risk, they also have the highest risk of harm from treatment.
  8. Thou shalt stop any treatment that is not of clear benefit.
  9. Thou shalt diligently try to find the best treatment for the individual because different treatments suit different people.
  10. Thou shall seek to use as few drugs as possible.” 

So, if you have to visit your GP surgery and your GP wants you to take a drug, always ask him/her to explain the risk over benefit.  Don’t be afraid to question your GP’s motives for wanting to put you on a drug, particularly if your readings are only slightly above normal. Sometimes watchful waiting and monitoring is the best course of action. Our own education and knowledge is the safest route to good health and a long independent life.

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