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Time to listen to patients about prescription problems



dr des spence duo 3x2

The Scottish Government is considering a petition from patients around prescription drug dependency, calling for action to recognise the plight of patients who have become dependent on benzodiazepines and antidepressants and provide them with timely and appropriate support.[1]

It comes as the Department of Health has announced a review of addiction to prescription medicines in England.[2] Yet another medical calamity unfurls.

The patients have suffered greatly and inexcusably. The authorities will point the finger at general practice but the blame lies with the medical elites, flawed research, NICE, the MHRA and Big Pharma.

I submitted a statement as a personal narrative of my experience through the past three decades.

This inappropriate intimacy powered our current prescription problems

Firstly, we need to understand the relationship between doctors and the drugs industry. It’s hard to explain the closeness of this relationship to an outsider. In the past, industry representatives were everywhere. They provided lunch, freebies – Filofaxes, computers, pens and the rest – and, supposedly, ‘education’.

They engaged with doctors outside work as well, took us out at night as junior doctors, invited GPs and their spouses for evening meals, flew groups of doctors all over the world to ‘conferences’ (nobody actually went to the conference lectures). Cash everywhere. If it moved, industry sponsored it. Christmas parties, leaving dos – you asked, they coughed up the cash. They flattered you and puffed up our already large egos. To say it was wholly inappropriate would understate the truth. Much of it still goes on today. And the industry is still everywhere in the NHS, the media and of course in Parliament. Little has really changed.

This inappropriate intimacy powered our current prescription problems. The industry in the 1990s suddenly got a conscience about ‘chronic disease’ and pumped money into charities and advocacy groups. This was especially in mental health. Not benevolence but financial malevolence. You only take an antibiotic occasionally and for a few days but psychiatric conditions are common, life-long, incurable and involve taking multiple medications with dose escalation. A business opportunity like no other. So industry co-opted ‘the psychiatric specialist’ and built their careers for them, with their names helicoptered onto ghost written research.[3] When it came to setting up a national adversity panel, guess who got an invite? The guidelines always seemed to promote new medications, perhaps unsurprising when you consider that over 75 % of the authors of the DSM – the diagnostic and statistical manual of mental disorders, the holy text of mental health – had declared links to industry.[4]

Then came ‘clinical depression’. Low mood for two weeks now became an ‘illness’ and swathes of the population were sick. This is an subjective definition with an entirely arbitrary cut off. Why not three weeks or six weeks? Might low mood be a normal response to a situation? It was peddled as ‘chemical imbalance’ but this is a simple myth, with no proven biological basis. But business is business and industry had a new medication to sell: Prozac. Safe, non addictive and supposedly highly effective. So in 1992 industry sponsored a campaign called ‘Defeat Depression’, endorsed by their friends the doctors. Prescribing went stellar. GPs were repeatedly told by our betters that depression was ‘underdiagnosed and undertreated’.

But guess what, depression wasn’t defeated. Years later it became clear that SSRIs (like Prozac ) don’t actually work for the most part.[5] Also patients struggle to stop these medications experiencing significant withdrawal symptoms. And this withdrawal was assumed to be a return of depression, so doctors advised patients to carry on taking antidepressants for years and even decades. But this advice was simply the opinion of the same financially conflicted specialists.

Patients complained about severe side effects, but no one seemed to care or even listen. Talk based treatment like counselling are effective and would have been cheaper to provide. But these facts didn’t stop the march of the medications. This was the same story for diazepam and sleeping tablets a generation before. Drugs that poisoned and undermined entire communities. No one ever learned. No one was ever held accountable, no one prosecuted and no corporation held responsible. Just a perpetrator-less crime.

Today history is repeating itself with painkillers. Pain is common, so again is a big business opportunity. Industry peddled the idea that strong opioid painkillers were ‘non-addictive’ if used ‘therapeutically’. If you questioned the dogma you were an ‘opiophobe’ and dismissive of people suffering. So prescribing went up and up. The pharmaceutical reps were everywhere. They focused on the pain specialist, wined and dined them, flew them on all-expenses paid trips to ‘educational conferences’ and doled out big cash to them to act as advisers or speakers. The message to GPs was the same, ‘underdiagnosis’ and ‘undertreatment’ of pain. So prescribing of strong pain killers tripled in 10 years.[6]

But guess what? These medications are addictive, dangerous in combination and have no long-term data on safety. With 90% being used in non-cancer pain, these are causing huge problems across the UK. But there are no support services for affected patients. Tens of thousands of people are inadvertently addicted to these medications. Specialist pain clinics are making the problem worse and have no insight into the harm they are doing. All these problems are not the fault of patients. These problems are the responsibility of the medical profession. We are harming patients every day and everywhere across the country. We seem to have learnt nothing from history.

What to do? Let’s see what the politicians come up with.

Dr Des Spence is a GP in Glasgow

References

1. Scottish Parliament Petitions: PE01615

2. Mahase E. Government launches major review into prescription drug addiction. Pulse; 24 January 2018 

3. Matheson A. Ghostwriting: the importance of definition and its place in contemporary drug marketing. BMJ 2016; 354: i4578 

4. Spence D. The psychiatric oligarchs who medicalise normality BMJ 2012; 344: e3135 

5. Spence D. Bad Medicine: The rise and rise of antidepressants. Br J Gen Pract 2016; 66: 573

6. Spence D. Bad Medicine: The medical untouchables Br J Gen Pract 2017; 67 (661): 363