A ghost in the machine

I suppose most people missed this story about life expectancy in the UK. If you didn’t pick it up, this article comes from the Doctors net website. A site for doctors registered to practice medicine in the UK.

Life expectancy fall alarm 14/02/2014

The life expectancy of England’s elderly population has fallen for the first time, it was reported last night. Women at the age of 75 can expect to live a little less longer than they would have at the beginning of the decade, according to new figures.

The figures for 2012 are still provisional and represent a reduction of two and half months in life expectancy for women at the age of 75.There was no change in life expectancy for men, who could expect to live 11.3 years.

The Department of Health calculations, obtained by the Health Service Journal, show that life expectancy for women at that age fell from 13.2 years to 13 years. The figures may reflect the growing problems of caring for an elderly population – or simply growing numbers of elderly people.

John Newton, of Public Health England, told the journal: “Life expectancy reflects what has happened in people’s lives, and these people were born in wartime, when there were profound changes in diet. We have seen an unprecedented increase in life expectancy and it’s possible that is coming to an end.

“But we do also expect fluctuation. As we have an older population, the proportion of deaths that will fluctuate due to flu and cold weather is greater.

So it seems that life expectancy in the UK is falling amongst elderly women, and it is staying stationary for elderly men. Which is rather the opposite of what was supposed to happen, and reverses many years of increasing life expectancy.

Why is this happening? Ten years ago the UK Government embarked upon the most expensive, and extensive, initiative ever undertaken in preventative medicine. The Quality Outcome Framework (QoF). This was launched with a great fanfare.

QoF is a system whereby GPs have to screen the entire population for conditions such as diabetes, high blood pressure, chronic kidney disease, high cholesterol, etc. etc.

Once any early stage diseases had been picked up, treatment is instigated. Then there is regular monitoring to ensure that targets for blood pressure lowering, blood sugar control, and suchlike were met. This system has cost billions upon billions of pounds.

It was supposed to stop people dying prematurely from diseases, or conditions that could be properly ‘treated’ and ‘controlled.’ Because the elderly are, by the nature of being elderly, far more likely to have various early stage diseases, and are therefore at highest risk, this is the population that has been most tightly monitored and ‘treated’.

I work, part-time, in Intermediate Care. A unit where elderly people who have had an accident, broken a hip, or suffered other acute illnesses are cared for. Our job is to get them as fit as possible to return home. There are nurses, physiotherapists, occupations therapists, and me, sorting out underlying medical conditions such as anaemia. Some patients arrive from the community, others from hospital.

I did a small audit last year, and found that the average number of drugs that our patients are taking when they arrive in the unit is ten point three. That is, ten point three different drugs. Some of which are taken three or four times a day. So, a total of twenty or thirty tablets a day, in many cases.

This is the very definition of polypharmacy. And how much harm could polypharmacy do? Well here is a study from Israel, looking a study where people in nursing homes had drugs discontinued [They stopped as many drugs as was considered ethical]. Here is the abstract of the paper.

The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people.

Background:

The extent of medical and financial problems of polypharmacy in the elderly is disturbing, particularly in nursing homes and nursing departments.

Objectives:

To improve drug therapy and minimize drug intake in nursing departments.

Methods:

We introduced a geriatric-palliative approach and methodology to combat the problem of polypharmacy. The study group comprised 119 disabled patients in six geriatric nursing departments; the control group included 71 patients of comparable age, gender and co-morbidities in the same wards. After 12 months, we assessed whether any change in medications affected the death rate, referrals to acute care facility, and costs.

Results:

A total of 332 different drugs were discontinued in 119 patients (average of 2.8 drugs per patient) and was not associated with significant adverse effects. The overall rate of drug discontinuation failure was 18% of all patients and 10% of all drugs. The 1 year mortality rate was 45% in the control group but only 21% in the study group (P < 0.001, chi-square test). The patients’ annual referral rate to acute care facilities was 30% in the control group but only 11.8% in the study group (P < 0.002). The intervention was associated with a substantial decrease in the cost of drugs.

Conclusions:

Application of the geriatric-palliative methodology in the disabled elderly enables simultaneous discontinuation of several medications and yields a number of benefits: reduction in mortality rates and referrals to acute care facilities, lower costs, and improved quality of living.

The first thing to say here is that, if there ever was a ‘war’ against polypharmacy, then polypharmacy won a long time ago…at least in the UK.

For those who find scientific papers somewhat opaque, the key point from this paper is the following

The one year mortality in those who did not have their medications reduced was 45%

The one year mortality in those who did have their medications reduced was 21%

This is a fifty three per cent absolute reduction in overall mortality risk in a year. Which is a better figure than I have seen for any drug intervention, ever, anywhere. So it would seem that the best possible drug treatment discovered…. is to stop taking drugs. As an added bonus you save lots of money, and make the patient feel much better, all at the same time.

Just one paper? No, of course not. There are a number of different studies demonstrating that discontinuing medication in the elderly is a good thing to do. A review paper in the Journal of the American Medical Association (JAMA) came to the following conclusions:

‘The finding that simultaneous discontinuation of many drugs is not associated with significant risks and apparently improves quality of life should encourage physicians to consider testing this in larger RCTs (randomised controlled studies) across a variety of medical cultural settings. Polypharmacy may have different faces in different countries or clinics but there is no doubt that the problem is global. This approach has international relevance; it combines our best existing evidence with patient-focused care while actively avoiding extrapolation from inappropriate populations where no evidence exists for treatment in elderly patients.’

In fact, I cannot find any evidence that polypharmacy, however you define it, does anything but harm. In the face of such evidence what did the UK authorities decide to do? Why, they set about create a system designed to drive the biggest explosion of polypharmacy ever seen. What else would you expect them to do?

So why has the mortality gone up in the elderly population in the UK? Well, I know where I would put my money. On the very system designed to stop them dying in the first place.

41 thoughts on “A ghost in the machine

  1. jojo

    I also work in intermediate care/aa and am alarmed at the huge array of drugs administered to the elderly – yes, we’ve had a situation recently (your pet subject Malcolm) of an “end of life” patient urgently needing liquid statins as she could no longer swallow. Sourcing the said drug was time consuming and costly!!!!!

    Reply
  2. mikecawdery

    Statins are known to cause muscle adverse reactions; the heart too is a muscle.

    Congestive Heart Failure Epidemic

    The attention paid to the incidence of adverse reactions, particularly muscular ones, which can be as high as 1 in 4-5, is significant by its absence. There is the case of the missing epidemic of congestive heart failure announced by the NHBLI and also found on the CDC web site. This information was subsequently removed from both web sites for unknown reasons but can still be found at:
    http://library.thinkquest.org/27533/facts.html.

    It seems that the “authorities” wanted nothing to do with this “epidemic” which, I am informed by an eminent US cardiologist, continues to rise. The following extract may explain why! Some studies show that statins may well be causal (Charach G, et al. Low levels of low-density lipoprotein cholesterol: a negative predictor of survival in elderly patients with advanced heart failure. Cardiology 2014;127(1):45-50.;Passi S, et al. Statins lower plasma and lymphocyte ubiquinol/ubiquinone without affecting other antioxidants and PUFA. Biofactors 2003;18(1-4):113-24.:Langsjoen PH, et al. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. Biofactors 2003;18(1-4):101-11.)

    The heart, as a muscle (a very active one), is not exempt from statin toxicity. May be this is why the incidence of congestive heart failure has steadily risen in step with the widespread adoption of cholesterol lowering therapy (statins from the late 1980s). This epidemic simply disappeared off two US government web sites, namely the CDC and the NHBLI. In my experience epidemics, rise, peak and decline; they certainly do not simply disappear without explanation. If I spotted this association, it is certain that others did and this information was certainly “not favourable” to commercial interests.

    Reply
    1. mec76

      Mike – I checked out the link you posted. Downloaded it, printed it out, copied (Ah-Ha) and sent it to a number of people, including doctors various (family). Was looking through my downloads earlier, Ho-Hum. Document no longer available. Has been removed from that sie. However, I do have copies.
      Can’t invent it can you.

      Reply
  3. james

    Dr Malcolm wouldn’t be better to invest in more placebo pills since the over-medication can not always be blamed on the consulting physician. It is a well know fact that patients often ask, nay, demand a pill for whatever ails them.

    Reply
  4. Charlie

    Here is another example of needless treatment and over medication for old folks one that is now being heavily promoted and is much in vogue at least in the USA.

    The evidence provided in a research paper titled “Prevention of Herpes Zoster in Older Adults” indicates it’s not nearly as effective as the CDC would have you believe.
    Under the section heading Practice Pointers, Dr. Brownstein found these gems:

    “[T]he author states that, over a median surveillance period of 3.12 years, with over 52,000 participants, there was a 51% relative risk reduction in confirmed cases of herpes zoster in those that received the vaccine. Furthermore, the author stated that among those aged 60-69, the number needed to treat to prevent one case of shingles was 50. Among those 70 years and older, the number needed to treat was 100.

    “These numbers show that, in those aged 60-69, the shingles vaccine was ineffective for 98% (forty-nine out of fifty) of those studied. For those aged 70 and older, the vaccine was 99% ineffective, since 99 out of 100 received no benefit.”

    So according to the data, the shingles vaccine was a 98 percent to 99 percent failure. Also, the number needed to harm from the vaccine was 2.8. That means that for every 2.8 vaccines administered, one patient was harmed. And for every 100 vaccinated, one patient suffered a severe adverse reaction like a rash, fever or hospitalization.

    Dr. Brownstein presented this evidence in the form of a letter to the editor of the American Family Physician Journal. The letter was rejected without explanation.

    Reply
  5. Anne

    Thank you for putting into words what we have all felt for a long time. It is most encouraging to hear facts told as they really are.

    Reply
    1. Jennifer

      Elaine. In 1992 there was a governmental White Paper launched, called “the Health of the Nation”. The aim was to improve, or at least maintain, health, rather than concentrating on treating existing conditions. All very interesting, BUT, I recall at that time, Student Nurses being endlessly questioned about its ideals, during their placements on busy wards where they were supposed to be learning the art and craft ( and science) of caring for the sick!
      Nursing was being changed from its reason d’etre of care of the vulnerable to managing the healthy! And just look where it has got us!!!!
      And they wonder why Nurses are struggling to express feelings of empathy and care? Could it be because they are overloaded with clinics full of the worried well, rather than spending precious time actually confronting the complicated issues involved with the chronically sick.
      Since when did ticking monitoring forms of a chronic condition actually help the patient manage their condition? But a bit of time spent actually discussing it might prove beneficial, or God forbid, improve it! But that would fly in the face of Big Pharma, might it not?

      Reply
  6. Tom Welsh

    How does the Hippocratic Oath go? Wasn’t there something about “First, do no harm”? Seems a LOT of doctors could use a quick refresher on those four little words.

    Reply
  7. Spokey

    I see this as evidence that studying the effects of polypharma on mortality retroactively causes higher early mortality rates. Therefore doctors shouldn’t be looking at the data. Look, the data proves it, now give that back.

    Reply
  8. David Bailey

    Since statins can cause severe muscle problems, and memory loss and confusion, I wonder if some of the patients were only in nursing care because of their drugs!

    Reply
  9. Professor Göran Sjöberg

    I am now finally realise why I am still alive as a victim of a very severe heart attack 15 years ago.

    I refused all medication and also the offer of a by-passoperation!

    I guess that this also has saved a lot of money for the tax payers in Sweden and since I have also been able to work full time now until 67 and could have continued for a couple of more years, since I am very fit, if the system had not kicked me out. (Well I am still on 10% at Chalmers .) So I have not taxed the system – on the contrary I have been able to continued to contribute to the system well taxed during these 15 years.

    What you say about “de-mediciation” also fits even “younger” guys like me!

    I an now reading an astounding book on this theme, which adds to the fire:

    “Deadly MEDICINES AND Organised CRIME – How big pharma has corrupted healthcare”

    by the danish professor Peter C Gotzsche.

    http://www.amazon.com/Deadly-Medicines-Organised-Crime-Healthcare/dp/1846198844

    This book has, for sure, taken away the last illusions I might still have had about medicine as a kind of healthcare. The danger reading the book is that you might get too depressed about our society and have to look for care – but where?

    Reply
    1. Dr Paul Travis

      I too have read this book by Peter C Gotzsche. It should be mandatory reading for all doctors and medical students. As he states, all drugs are poisons or remedies, depending on the dose. For more than 2 decades I have treated and advised my patients like any other UK GP in good faith and wanting ‘to do the right thing’. Now I know how easily I, like many others in my profession, have been misled and deceived. Polypharmacy has always concerned me and occasionally I’ve had the courage to stop many unnecessary drugs taken by elderly patients, only to be criticised by colleagues and the drugs simply re-started. ‘Medicine is broken’ to quote Ben Goldacre. Quite.

      Reply
  10. Fiona Weir

    Won’t decrease in life expectancy be accellerated in the near future because of the ever-more unhealthy lives people are living? Will some of the super-obese, exercise-
    less be around to receive medication, in excess or otherwise?

    Reply
  11. Robert Park

    Yes, I also read the article. There are so many situations which could be raised to support your view but here is one that was mentioned on the Net some years ago. Unfortunately, the tale cannot be confirmed but the following is the thrust of what was said.

    Apparently there were four cases globally where surgeons took industrial action. During those events the death rates dropped dramatically which almost put Undertakers out of business; need more be said?

    If I can raise a point on euthanasia here; has anyone ever heard of a queue for hospices?

    Reply
  12. jojo

    It also makes me question the wisdom of part of my teams job, which is going to visit folk simply to prompt meds as often as four times a day !!!!!!

    Reply
  13. Flyinthesky

    The greatest advances in longevity, despite what big pharma and the health care professionals, both wishing to aggrandise and empower themselves, tell us, have been shelter, nutrition and sanitation. I proposed an ignorant theory a few years ago that longevity was about to peak. The principal drivers of the plateau and subsequent fall are threefold, we are now too clean, losing our natural defences, hence the rise of succumbing to previously survivble infections. Our nutrition has been monetised to such an extent that producers of convenience foods, that people in ever increasing numbers have become reliant on, are now competing on price leading to the inevitable consequence, less nutrition and more empty and often toxic fillers. Then there’s big pharma’ every patient must be monetised, the most income has to be extracted from every one without doing any percievable harm, emphasis on percievable.
    The problem we now face is big pharma is now on the upper edge of its potential, it now does do actual harm and has been doing so for some considerable time but it can employ the best legal departments to protect its own interests, despite its claims and its foundations and its research it is the most evil business on the planet, bar none. It makes the back street drug dealer almost saintly.
    The government doesn’t care about us, any of us, despite their claims, only how much you cost. They have been persuaded by big pharma that a few million here and a few million there will mitigate their responsibility despite the effects that we suffer.
    “be clear on cancer” every GP must poo themselves at every new emmanation, waves of worried well overwhelming surgeries. We have been so conditioned to be afraid of dying we’ve forgotten how to live.
    Despite being diagnosed with terminal cancer, you wouldn’t want me as a patient Malcolm, I question everything, I don’t have a GP and haven’t had for over three years. None are willing to accept my conditions: You don’t waste my time and I promise I’ll never waste your’s.
    As an afterthought my grand mother eating, she put so much salt on her food you’d think it had beeen snowing, she managed 92 and was still shopping, half a mile each way till she was 90. She always wondered what the pink bit in her bacon was, meat, ah, something my dad used to eat.
    Bacon print, anyone remember that, where the bacon was placed on the sandwich and then removed. Leaving a fat print of flavour to be consumed with gusto.
    For our American cousins, I see a lot posting here and long may our friendship last. Your insurance companies take the place of our government, you are allowed whatever tests, investigations and drug administrations that your insurance company will allow, the reality remains the same, percieved mitigation and reduction of liability. If you persuade your clients to accept this medication your overall liability for expendidture will be reduced.

    Reply
    1. Christine Whitehead

      Flyinthesky
      You say: “I don’t have a GP and haven’t had for over three years. None are willing to accept my conditions: You don’t waste my time and I promise I’ll never waste your’s.”
      Is that because you refuse to take the offered drugs or because you won’t participate in the quizz games every 6 months.
      I’m sure we all know the ones e.g.-
      Do you eat 5 a day? answer: sometimes 3, sometimes 7 is that naughty?
      Do you walk fast, slowly or moderately? – answer: please define fast slow or moderate.
      Do you get depressed? answer: every time I open my bank statement.
      etc

      Whoever dreamed these up has the brains of a chocolate teapot.

      Reply
      1. Flyinthesky

        I won’t partake in either but in my case it’s much bigger, we have a catalogue of family disasters, two of them fatal, with the medical profession. Out of respect for Malcolm’s efforts I won’t expand on them here.
        From my perspective I wan’t to consult a doctor if I’m unwell, I don’t wish to be summoned to facillitate their next earning opportunity, notwithstanding that worrying about blood pressure et al is as harmful as having it in a lot of cases. Life is too short for the inevitable confrontation.
        As in the main doctors are no longer familiar with their patients I could get all I needed from a walk in centre including a referal to a consultant.

  14. zooko

    Dear Dr. Kendrick: Could you please give more information about the study from Israel and the review paper in JAMA, so that I could look them up and read them myself?

    Also, check out our blog: http://www.ketotic.org/ You may find it relevant to your interests!

    Reply
  15. dearieme

    Who is best placed to review and winnow one’s drug list? The GP in a ten-minute consultation? Certainly not the specialists at the hospital who are, necessarily, specialists. The Secretary of State for Health? How about an App?

    Reply
  16. Jennifer

    It is donkeys years since I worked on a medical ward where elderly people were admitted for “medication reviews”, because the complications associated with poly pharmacy were being highlighted. It was considered diligent care that close monitoring was needed to assess suspected detrimental drug interactions, and/or withdrawal.
    Today we are bombarded with greater volumes of drugs. Infinite variations of drug cocktails must be responsible for some health problems. A powerful computer would struggle to disentangle the side effects which are menacing the lives of recipients of the dreaded “repeat prescription” mentality, so prevalent in today’s NHS. A ward-based physician could not be expected to have the time or resources to undertake (now that’s an appropriate word!) such a chore, so the oldies just go on consuming ad infinitum.
    i’ve stopped the lot! I’ve also advised my local pharmacy to refrain from contacting me every 4 weeks to ask what I would like to have prescribed, because, whatever I said….the same load was delivered regardless. Utter waste, which if repeated Nationwide is a disgrace of phenomenal proportions.
    Good grief….when will it all get sorted out? It is getting beyond my understanding.

    Reply
    1. celia

      So the pharmaceutical companies continue to win out at the expense of the patient! It seems we live in a mad world, where homeopaths and medical herbalists are being squeezed out by EU Regulations requiring “Evidence Based Medicine”, yet Big Pharma is allowed to carry on destroying lives, and very few people in power seem to notice…

      Reply
      1. Flyinthesky

        It’s pharmaceutical companies in the main that have lobbied the government, the eu and I suspect the UN for these changes, from their perspective the last thing they want is for us to be able to look out for ourselves with inexpensive unpatentable products.

  17. Pingback: A ghost in the machine | Bydio

  18. Suzanne Looms

    I’ve seen a number of elderly people on multiple meds. They/their carer says that the GP has no idea what meds they are taking and rely on the patient/carer to tell them. Zero information about adverse effects and no particular interest, it seems.

    Reply
  19. Marie

    My father
    A patient story

    When my father was 95, he had to spend one week in a nursing home here in Sweden.
    On return, I immediately understood that he had been drugged.
    During his stay they had added another two medications (Aricept and Mellaril) to his very
    long list.

    His legs could no longer support him, his face was like mask, he had a big bruise on his forehead, his glasses didn´t function and he couldn´t talk properly as his voice was too weak. My brother-in-law had to lift him from a wheel chair straigth to his bed.
    I became very angry and started to look for information on the Internet and in books (I have not stopped).

    I saw that Aricept´s efficiency was being questioned: It could also cause lots of side effects. Mellaril (?) was withdrawn in England due to serious side effects, but was prescribed in Sweden. There was no verbal or written information for the family.

    Naturally, I protested. I wrote several letters to the prescribing doctor.
    I received a reply after my father had passed away (some months later), The doctor defended his prescribing of Aricept with the words – I though about your father´s future!

    I am sure my father would have been quite pleased to live a shorter – but better life.
    He was a perfect example of Health Care gone wrong.

    My father went through many medical experiments.
    He was prescribed steroids (for asthma). In those days, no-one worried about the long term effects – it was a “miracle drug”.. After some years, his own production stopped and he had to take injections/pills for the rest of his life just to survive.

    Today, there are many “miracle drugs” on the market – who cares about their long term effects and what is the present definition of poly pharmacy (how many medications) ?

    Reply
    1. jacklabear

      You don’t need a doctor to tell you to stop taking a drug that is causing unacceptable side effects.
      Just stop taking it!
      Of course I’m assuming that you are well informed enough to know what the drug does, whether or not abrupt discontinuation might be problematic, and what the risk benefit ratio (for you) of the drug is. But then if you had done that homework, you probably wouldn’t be taking the drug in the first place.
      My father is a physician and avoids doctors like the plague. He doesn’t know what his cholesterol level is and doesn’t want to know. He is doing fine at 83 years old.

      Reply
      1. mec76

        In total agreement, one does not have to take the drugs – you don’t even have to fill out the Rx, tear it up !

        Was with friends last evening. The father of one of them is in a nursing home, Alzheimer’s. He is fast deteriorating. I asked what drugs he was on as much of what was described sounded like secondary effects to medication – and this view was supported by a nurse, who was part of our group. She (the daughter) said that she didn’t know, and didn’t want to know. That is so sad.

        I dread that I ever end up in one of these nursing homes. Shudder.

      2. Flyinthesky

        I used to have a takaway shop, I had few doctors as clients. The elder of the local GP practice challenged me one day “how do you keep so well” easy i said, “avoid you”. He thought that was most amusing.
        The younger of the practice was hypersaltophobic, the modern trend, I used to torment him with the salt shaker. He would visibly quiver at the thought of it.
        The same chap as the GP to another customer told him he wasn’t allowed salt on his fish and chips anymore. Frank, mid to late eighties, was as sharp as a tack used to get lunch for all his neigbours in the sheltered accommodation estate, used to remember about a dozen orders, had the money calculated, knew who wanted what on what, I said what about yours Frank, I can’t have salt on my chips so they’re not the same anymore, I don’t want any. Over subsequent weeks that super sharp old chap retreated into himself and became dull and confused, I suspect he was prescribed statins, he died a few months later.
        My favourite doctor customer was a consultant surgeon and clinical director of a large hospital group. He used to order his tea and said shout me when it’s ready, I’m outside having a smoke.
        There are a few real people still in the profession, the problem is finding them.

  20. Catherine Reynolds

    In 1976, my grandfather was diagnosed with Padgett’s Disease. These days, it doesn’t seem to be anything too dreadful, as there are all sorts of therapies which appear to manage it pretty well. 38 years ago, though, it was a different matter. He was put flat on his back in a hospital bed, and subjected to a stringent 1000 calorie a day diet, for no apparently good reason. But, because he wasn’t allowed to sit up, he couldn’t actually feed himself, and it seemed hit and miss as to whether he ever ate a full meal unless he had a visitor to help him. He was taking a cocktail of 23 different drugs every day, and after four months in hospital, had made no improvement of any kind, except that they’d realised that keeping him flat on his back was pointless in every way, and he was now allowed to sit up. My mother and I (I was only 10) visited one Saturday to find he’d been packaged up into some sort of abdominal brace, as they were trying to get him walking again. My mother queried whether it had been put on correctly, as there were a couple of straps with buckles poking out just under his chin, and she couldn’t fathom what these were for. He was seriously uncomfortable, too. My mother was right – it wasn’t fitted correctly. My granddad never walked again, indeed he had to go to a nursing home after being discharged from hospital, where he eventually developed kidney failure which killed him in the end. My parents always felt that the cocktail of drugs he was taking had played a part in his rapid decline, and indeed, were never told in detail what they were and why he was taking them. This all took place over just six months. He was well in himself before going to hospital, in that he didn’t have anything like a heart condition, or lung disease, but, as we realised over the coming years, the Padgett’s Disease was causing certain symptoms such as pain, a rather pronounced “Charlie Chaplin” walk, and he appeared to have lost at least three inches in height. The hospital pumped him full of calcium, too, which his body just couldn’t deal with. You like to think that things have improved enormously in 38 years, but frankly, I don’t think so.

    Reply
  21. GG

    QOF have changed Gp consultations for the worse. This tick box culture has GPs interrupting their patients who are trying to get their story across in a few short minutes, to make sure they can tick the latest box. Problem with QOF tick boxes is that none of them relate to patients’ health and wellbeing improving. They are based on having registers for this and that, taking blood or other tests at said intervals and getting points for the current, most trendy of conditions (thus encouraging doctors to focus on these conditions because they give the most points).

    Why is it that no-one seems to ask the following:
    1 does being on the said register improve the patient’s health and wellbeing?
    2 does having the annual blood test improve the health and wellbeing of the patient?
    3 does encouraging the diagnosing and treating of the more trendy (more points) conditions improve the health and wellbeing for patients?

    Add in ‘long term’ before ‘health and wellbeing’ and we are touching on the topic being discussed.

    Giving doctors QOF targets changed how GPs listen to, diagnose and treat their patients. I noticed when visiting my GP with a symptom that he quickly said I should have tests done. No problems showed up in the tests so nothing more was done. I went back and asked about what I should do about the symptom and he more or less shrugged his shoulders. I later discovered that the tests done get QOF points. So GP gets the points and I still have my symptom several months on. I am assuming that there are no more QOF points to be had for my symptom therefore GP no longer interested.

    I can totally understand why flyinthesky does not have a GP.

    Reply
    1. Dr Paul Travis

      I couldn’t agree more GG. Quality Outcomes Framework (QOF) has taken care away in favour of points. A disaster. Your experiences and those of flyinthesky are very typical in my experience.

      Reply
  22. GG

    The recent BBC Horizon programme about The Power of the Placebo was very interesting and demonstrates how powerful taking a placebo can be, even when the patient knows it is a placebo. It is currently available on BBC iPlayer.

    Reply
    1. Malcolm Shepherd

      Speaking as a student of psychology, I find it amazing that so few in the medical profession have understood the workings of a placebo. Even some involved in actual pharmaceutical research haven’t grasped the basics and so are unable to properly control their studies. Certainly the aforementioned BBC program “The Power of the Placebo” provided only misinformation.

      The efficacy of a placebo comes not from the pill itself but from the care and concern lavished by the physician on the patient and from the confidence the patient holds in said physician’s capacity to heal. This is why homeopathetic doctor can get remarkable results from an hour long consultation followed by an expensive injection of pure water. The effect is entirely placebo.

      So I shouldn’t place too much confidence in the polypharmacy study described by Dr Kendrick above – it was clearly improperly controlled! What should have happened is
      1) a consulting doctor should have assessed ALL the patients in the ward for potential drug discontinuation, with every patient receiving the same amount of care and attention
      2) blind to the consulting doctor, a study administrator should then have randomly allocated 50% of the patients to drug continuation and 50% to discontinuation with the real drug replaced by a placebo. Neither nurses nor doctor should know who is being discontinued and who continued.

      I’m willing to guess that if the study had been properly controlled in this way then the generalized outcome of discontinuing unnecessary drugs would have been neither positive nor negative for the patient and the only real saving would have been the cost of the drugs themselves. Unless of course a given drug was actually toxic in which case there would be a mortality improvement from the withdrawal of that specific drug but one would never expect a generalized mortality advantage from withdrawing a host of drugs as this ill-controlled study seems to show.

      Reply
      1. Dr. Malcolm Kendrick Post author

        Malcolm. I would focus on your comment ‘Unless of course a given drug was actually toxic.’ Actually I don’t think any given drug will be that toxic, but I believe that the combination of many drugs is toxic. That is why elderly people are now living shorter lives than they were 10 years ago. Polypharmacy is toxic to the human body, it must be. Do any benefits outweigh this toxicity. I don’t think so. Doctors should choose a maximum of four drugs for any patient, and get rid of the rest. (There may be rare exceptions to this rule).

  23. Jack

    The side effects of most of big pharma’s drugs can be up to ten times worse than the condition they are supposed to cure! Most people don’t know that in the U.S. Medical Doctors are visited by pharmaceutical salesmen and sales women who take them out to lunch and push them to prescribe whatever drugs they are peddling at the time. They often offer the Doctors a financial “kickback” (a sales commission) on all prescriptions that they write for whatever drugs the salesperson is selling.

    I agree with Ceila’s comment as well. Nobody should have a monopoly on healing.
    Nobody.

    Thank you for posting the article.

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s