The reckless and even the enforced medication of the population grows apace. State bodies are pressing for widespread or universal medication. The National Institute for Health and Care Excellence (NICE) recommends the universal use of statins by men over 50 and women over 60, ministers are considering making compulsory the addition of folic acid to flour and councils are being encouraged by Public Health England to put fluoride in the water supply .
That is direct government action. But there are many drugs with potent side effects which are being given out wholesale without any government interference. Potentially the greatest risk comes from antibiotics to which resistance is being built up all the time. The World Health Organisation warned this year that overuse was potentially creating a crisis more serious than Aids . Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security, claimed : “A post-antibiotic era — in which common infections and minor injuries can kill — far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”
Antidepressants are being prescribed in record numbers and the side effects, which often make people feel as though they are going around in a mental fog, can make people feel the cure is worse than the disease. Moreover, they can be prescribed for people who either are not seriously depressed but suffering from a physical illness or people whose severe depression is the consequence of a physical illness.
There is also the problem of addiction to such drugs with severe withdrawal symptoms experienced by some people, symptoms such as these suffered by a patient identified only as Henry: “It was torture. I thought I was going to die, and I didn’t care. For two years, I was in severe physical pain and so weak I lay all day on the sofa. My cognition was severely affected, I was dizzy, with blurred vision, I couldn’t read a bedtime story to my son and couldn’t remember things that had happened just a few seconds previously.”
But even where there is no psychological problems or unpleasant but not immediately obvious damaging physical effects, drugs can have dramatic consequences. For example, aspirin is routinely prescribed to thin the blood, especially to those who have suffered heart attacks, but recent research found that aspirin’s daily use “ leads to 37 per cent increased risk of internal bleeding and 38 per cent increased risk of hemorrhagic stroke,” while the long term use of the contraceptive pill doubles the risk of glaucoma..
Probably the most controversial widely used medication in Britain at present are statins. Side effects can be extreme. Statins (which are used to reduce cholesterol) have been the subject of much complaint by patients. There are studies which claim that statins have little or no side effects, but the catalogue of complaints against them is so huge that it is difficult to see how they could have come to such conclusions.
I have taken statins for many since suffering a heart attack, I can I can vouch for the fact that they have powerfully obnoxious side effects. Luckily I did not suffer psychotic episodes such as those which afflicted the unfortunate Dr Allan Woolley before his suicide, which was attributed to the side effects of statins . However, I have experienced severe disabling symptoms such as intense aching, especially in the hands, a permanent fatigue and a diminution of mental function, especially of memory and concentration (I had to consciously concentrate on what I was doing rather than simply doing it without thinking, while my power of immediate recall, previously very good, became unreliable.
I only realised statins were responsible for such symptoms in 2007 – for years I attributed them to the process of ageing and the after effects of the heart attack – after I read several articles by Dr James Le Fanu who both questioned the general value of statins and described the side effects: ” Statins are useless for 95 per cent of those taking them, while exposing all to the hazard of serious side-effects and detailed the side effects….they seriously interfere with the functioning of the nerve cells, affecting mental function, and muscles.” (Sunday Telegraph 17 3 2007). He concluded that only those with a personal or family history of heart trouble should take them.
But even that advice is debatable. Eating an apple-a-day is as effective as taking statins according to a recent piece of research, viz:
“Prescribing either an apple a day or a statin a day to everyone over 50 years old is likely to have a similar effect on population vascular mortality. Choosing apples rather than statins may avoid more than a thousand excess cases of myopathy and more than 12 000 excess diabetes diagnoses. The basic costs of apples are likely to be greater than those of statins; however, NHS prescription prices and convenience may drive people to purchase their apples from a store rather than through a pharmacy, thereby reducing direct NHS costs, or the NHS may be able to negotiate apple price freezes (although defrosted apples may not be so palatable).23”
There are also doubts about whether cholesterol levels have anything to do with heart attacks and strokes, so the concentration on bringing down cholesterol levels may be pointless.
It might be thought with the ever increasing range of medications available that overall life expectancy would be increasing and go on increasing . Not so. In recent years in the UK the trend towards greater life expectancy after the age of 65 has flat-lined for men and actually declined for women. “Life expectancy at age 65 in 2012 has been projected as 18.3 years for men and 20.6 years for women on average….In 2008 life expectancy post 65 was 19 years for men on average and 21.3 years for women on average. In 2010 it was 18.7 for men and 21.1 for women.”
This suggests that medication of the elderly is at best ineffective in extending lives on average and may even be a cause of the stagnation of increases in life expectancy amongst the old.
There is also a moral question, namely, how much medication should be given to a patient regardless of the quality of life they can experience? The idea that living is desirable regardless of the nature of the life is difficult to sustain morally. That is particularly true of the old. I have never encountered anyone over the age of 85 whose life I have known in some detail who has been averagely happy or physically comfortable. Almost invariably by that age the body has developed some serious malady whether physical or mental. That is not to say such elderly people generally want to die. Rather, it is simply that the life being led is normally miserable at worst and unfulfilling at best. If they are loaded down with medications, many or all of which will have obnoxious side effects, this may extend their lives by a few months or years, but the patient may well feel that there is a case for saying let nature take its course if those few extra months and years will be suffered rather than enjoyed because of the side effects of medication.
Why do patients submit to drug regimes regardless of the ill consequences? Patients generally trust their doctors and are inclined to accept advice in the vast majority of cases. But even if they do not want to carry on with a drug because of the side effects – and many commonly prescribed drugs have effects which make the enjoyment of life seriously difficult – they find it difficult to refuse a doctor’s advice. Often it is not a simple matter of refusing a single treatment, because many patients, and especially elderly ones, will have a range of ailments and will fear that refusing to take one medication may ruin their relationship with their GP or a hospital consultant, with a consequent diminution in the quality and scope of their future medical care. Even if unfounded , such fears will drive patients to carry on with medication which is causing them serious discomfort.
Things could be improved if doctors were required to discuss the side effects of drugs with patients. The only warning I have ever been given voluntarily by a doctor – and I have spent a great deal of the past twenty years with chronic complaints – about side effects is drowsiness, yet most drugs which seriously interfere with the natural workings of the body will have a list of serious side effects. For example, diuretics, a very commonly prescribed drug to increase fluid removal from the body has these side effects according to the BUPA guidance :
Side-effects of diuretics include:
mild gastro-intestinal problems, such as feeling sick
a fall in blood pressure that is related to posture (postural hypotension), which causes you to feel faint or dizzy when you stand up
altered levels of salts in your body, such as low levels of potassium (hypokalaemia) and sodium (hyponatraemia)
Less common side-effects of diuretics include:
gout (a condition that causes pain and swelling in your joints)
impotence in men (the inability to achieve or sustain an erection during sex)
certain blood disorders, which can make you more likely to get infections
What can be done to reduce overmedication? First, if doctors explained the side effects to patients that in itself would probably reduce too ready prescription of medicines because the patient would be put off taking those with serious side effects simple by their recital by the doctor and doctors would be much less likely to prescribe such drugs unless they honestly believed a patient desperately needed them if they had to explain the side effects and overcome the resistance of patients who did not really need the medication.
Second, non-medical directions and incentives to doctors to prescribe certain medications widely, whether that be government authored or supported schemes such as folic acid in bread or drug companies peddling medicines to doctors, especially GPs, which materially benefit doctors should be banned.