The therapeutic revolution of the post-war years ranks amongst the most impressive of all human achievements. So dramatically successful has been the assault on disease that it is almost impossible to imagine what life was like back in 1945, when there were no drugs for tuberculosis or schizophrenia or rheumatoid arthritis, or indeed for virtually any illness that a doctor encountered; a time before open heart surgery, transplantation and cures for cancer. These and a multitude of similar developments have been of immeasurable benefit in freeing people from the fear of illness and untimely death.
Yet, as Professor Joan Busfield from Exeter University argues – in a paper, “A Pill for Every Ill”, in the Journal of Social Science and Medicine this month – there is something very peculiar going on to account for why, over the past two decades, the Health Service’s drugs bill should have exploded, with little evidence of any measurable improvement in the nation’s heath.
From £4billion a year in the early 1990s, the cost of NHS prescriptions had topped £10billion by 2006, is now in the region of £18billion, and is expected to soar to £24billion by the middle of this decade. During this time, Professor Busfield points out, the average number of prescriptions issued per head of population has doubled to 16 per year. Millions of the healthy young and middle aged seldom see a doctor, so this can only mean that many, especially in the older age group, must currently be taking a fistful of drugs every day.
All drugs will have adverse effects in some people, so this cigarette-store.biz/info/vogue-style-vogue-cigarettes-advertising-campaign for polypharmacy will have been paralleled by the problem of iatrogenic (or doctor-induced) illness – as epitomised by Derrick Baxby from Liverpool, who discovered on leaving hospital after a coronary that he was expected to take seven drugs a day. He read the leaflet that came with each and calculated they offered him 130 side effects. “All could cause nausea and vomiting,” he writes in the British Medical Journal. “Most could cause kidney or liver problems; five, rash or itching; four, diarrhoea or constipation; four, headaches and four chest pain or palpitations.”
What accounts for this state of affairs? No doubt, as the title of Professor Busfield’s paper implies, public attitudes have changed: people are less stoical than in the past and expect a pharmacological remedy for their ailments, no matter how trivial. More importantly, the driving force behind the rising NHS drugs bill is the cynical recognition by the pharmaceutical industry that its future profitability requires a shift away from treating illness to “medicalising the normal” – and creating a demand for its products.
This takes several forms, the most successful of which is the enthusiasm for prescribing cholesterol and blood-pressure-lowering drugs to millions in anticipation of preventing heart attack or stroke in the future. Here, the likelihood of benefit to the individual is very small – it is estimated that 850 people need to take drugs to lower their blood pressure to prevent a single stroke. Thus, 849 people may be taking several tablets a day to no purpose. This “lack of benefit” is compounded by the fact that variables, such as blood pressure or cholesterol, rise with age and may be irrelevant in senior citizens. Too often, this factor is ignored, so many end up taking medication with almost zero probability it will do them good. Further profitable strategies include the promotion of “lifestyle” drugs for obesity, impotence and smoking cessation, and redefining psychological conditions, such as depression, as requiring medication.
If unchecked, it is anticipated this process could culminate in a state of Pharmageddon – where medical progress does more harm than good and the pharmaceutical industry kills the golden goose by bankrupting the health services of the Western world.
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