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A dinosaur and his drugs

Many of the drugs the Jobbing Doctor learned to prescribe as a medical student have fallen by the wayside - but not always for good reason

It is very hard to keep up to date in so many areas of medicine as a Jobbing Doctor. Every year there seem to be new classes of drugs, and they are so hard to get your head around: but you have to.

The drugs that I was experiencing as a medical student in the 1970s are very different to the ones we use today. Some have been superseded by better and newer agents, and others have just fallen into disuse.

I do not want to be thought of as a cave-dwelling dinosaur, and I do welcome new agents - I can remember amoxicillin being introduced as a better absorbed version of ampicillin. It was easy when you had only two beta-blockers - Inderal and Eraldin (neatly anagrammatising with each other). I have had to adapt to cephalosporins, and newer antibiotics; have been there at the birth of H2-blockers, PPIs, ACE-inhibitors, ARBs and all other assorted new groups. But I do use them.

For the young doctors of our era, don't get too smug - it will happen to you.

There are some agents that I am glad to see the back of. One of the more unpleasant ones was methylDOPA. This was one of the drugs of choice for hypertension when I was a student. I knew the pharmacology of it, and it did reduce blood pressure. It also had to be taken three or four times a day, and had a long list of side-effects, including profound exhaustion.

When I joined my practice, shortly after another young colleague, we set to changing all our patients off methylDOPA and onto newer drugs like propranolol and bendrofluazide. It was hard work, because the older doctors thought we were crazy, and we didn't have computers to identify who was on methylDOPA. We did it, because it was right.

I do feel, however, that some of the older drugs are being got rid of for no really good reason. There is still great merit in agents such as digoxin, chlorpromazine, tetracycline and others. They are cheap, effective and I know their strengths and limitations. The pressure is coming, of course, from the manufacturers of the newer agents, and their efforts to find newer markets for their drugs. Nowhere is this more prevalent than in psychiatric drugs. The effort to create new diseases for their new drugs continues.

I am married to an experienced teacher. She tells me that she is fed up with these new quasi-medical labels, such as ‘anger management issues' or ‘oppositional defiance disorder'. I agree with her. They are essentially badly-behaved children, and they are badly-behaved because of inadequate parenting. I could not tolerate the level of abuse teachers have to face. I cannot remember as a boy anything like this: if your school rang home to tell your parents about your poor behaviour, you got a second telling-off when you got home. Not now. Parents ring back and rant.

We now medicalise and medicate this type of behaviour. Can we really believe the numbers of people diagnosed with Attention Deficit Hyperactivity Disorder? Ritalin and melatonin are dished out at liberty. I have a teenager who has stopped his Ritalin without any discernible difference.

So, the Jobbing Doctor remains - slightly quaintly - to practice his eccentric medicine, and doesn't seem to be causing too may problems. People seem to tolerate the promazine that I continue to use, and indomethacin works for gout better than anything else, really. I wonder if my younger colleagues think of me as a paleolithic throwback, or a wise old sage?

Probably a bit of both.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.

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