Dr. James Le Fanu is a British retired General Practitioner, journalist and author of several books and is best known for his weekly columns in the Daily Mail, Daily Telegraph and the Sunday Telegraph.
When you woke up this morning how many pills did you line up on your bedside table? Do you know precisely what each one is for? Are you sure they are doing you good? Do you know if one drug conflicts with another or more importantly, are you sure that you need all of them in the first place?
In his recently published book, Too Many Pills, Dr. James Le Fanu questions the way modern medicine has evolved and in particular, the alarming trend to prescribe drugs to people who are not sick. With the advent of mass medication, called polypharmacy (meaning many pills) that has been thrust upon us in recent years, people are now being persuaded that, even though they may believe themselves to be fit and healthy, their levels of, say, blood pressure, cholesterol or glucose may be too high, thus transforming the ‘well’ into the ‘worried well’. The result is that they are prescribed drugs to correct the problems they didn’t know they had. Le Fanu suggests that the consequences of polypharmacy are vastly greater than is commonly appreciated, being responsible for a 75% increase in recent years in emergency hospital admissions for adverse drug reactions. He believes that this could be a contributory factor to the recent apparent decline in life expectancy.
SELL DRUGS TO EVERYONE
Le Fanu describes how this new concept of medical practice, polypharmacy first came about. It goes back more than forty years when Henry Gadsden, the then chairman of one of the largest drug companies, Merck, proposed that the future prosperity of the pharmaceutical industry would require expanding the market for its products beyond just treating the ill but to include the healthy as well. Ideally, he wanted to ‘sell to everyone’. Some time later, epidemiologist Professor Rose, backed up Gadsden’s proposition by saying that it was not just individuals who are ill, rather ‘the population is sick’ , therefore it would be more advantageous to treat the healthy to stop them from becoming ill in the first place. This of course played into the hands of the pharmaceutical industry who exploited the idea to its immensely profitable advantage over several decades.
Inevitably, the drug companies became too powerful so that when they had the idea of ‘selling to everyone’ they had to demonstrate the efficacy of the drugs for this much wider market. Costly clinical trials had to be organised and the only institutions with the necessary resources were the drug companies themselves. To recoup their substantial financial investment, it was essential that the results of the trials should be favourable, as invariably they proved to be. They thus became judge and jury of their own drugs.
Dr.Marcia Angell, in her book ‘The Truth about the Drug Companies’ observed ‘the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now principally a marketing machine to sell drugs of dubious benefit, it uses its vast wealth and power to co-opt every institution that might stand in its way, including the Drug Regulatory Authorities, Academic Medical Centres and the medical profession itself.’
PAYMENT BY PERFORMANCE
To make matters worse, in 2004, the long standing contractual arrangements by which family doctors are remunerated were overturned in favour of ‘payment by performance’. Introduced by the Blair government, QOF (Quality and Outcomes Framework) as it was called, offered a financial incentive to maximise the number of patients being treated for a list of conditions. This meant targets and rewards for meeting those targets. Inevitably, this set the scene for the over-prescribing of drugs so prevalent today. A typical situation would be when a healthy patient receives a letter from his GP inviting him to attend for a flu jab and whilst in the surgery he is persuaded to attend a ‘well man check-up’ whereupon, as a result of tests showing that his blood pressure was slightly raised. Regardless of the fact, as all know, that blood pressure fluctuates during the day, he is then prescribed pills and the patient finds himself unwittingly on the tread mill of drug treatment that he most likely never needed.
"THOU SHALT DO NO HARM" (Hippocratic oath)
Le Fanu explains what is now recognised as iatrogenic disease. This is where medical intervention is responsible for causing physical suffering rather than alleviating a condition. To illustrate this he refers to his weekly medical column. ‘Over the last ten years thousands of readers have written to tell me of the misery of the muscular aches and pains, lethargy, insomnia, impaired concentration, gut disturbances and general decrepitude caused by their drugs – and their almost miraculous recovery on discontinuing them.’ He cites one case in particular of a man in his mid-seventies who after a successful operation had been prescribed statins. He then became ‘increasingly decrepit, immiserated by pain and stiffness in his legs that his doctors were unable to explain.’ He was, however, determined to attend his son’s wedding in Hawaii. The long journey required him to use a wheel chair at the transfer stopovers. Arriving at his destination, he realised that he had forgotten to pack his cholesterol-lowering statins but ‘was so vastly improved after the three weeks of not taking them, he was able, on his return, to walk unassisted back through the terminal at Heathrow Airport.’ This brief account of a near miraculous restoration of this man’s health prompted a deluge of correspondence from others who had had a similar experience and been restored to health after discontinuing their medication.
Of course, as Le Fanu readily concedes, one must not lose sight of the fact that there have been many drugs launched on the market in the past that have indeed alleviated suffering and others that have almost wiped out diseases that were a scourge in years gone by.
In the chapter on diabetes, Le Fanu reveals a catalogue of catastrophic errors, from totally reversing the dietary advice of low carbohydrate/high fat diet (LCHF) so successfully used before, to lowering the bar which indicated a person was diabetic in order to increase the number of people requiring medication, thereby swelling the coffers of the drug companies. In Dr.David Unwin’s experience, ‘a low carbohydrate diet resulted in substantial weight loss in all patients and brought about normalisation of blood glucose. Seven patients were able to come off medication.’ However, the new dietary recommendation was that those with diabetes should be encouraged to ‘include starchy carbohydrate foods (bread, pasta, potatoes, noodles, rice and cereals) at each meal. Not surprisingly, they struggled to lose weight and lower their levels of blood sugar. This, Le Fanu believes, as much as anything else, ‘accounts for the four-fold increase in Type 2 diabetes over the past twenty-five years...an iatrogenic catastrophe of epic proportions.’
THE BETRAYAL OF THE OLDIES
Polypharmacy for the elderly can be particularly damaging. Although the oldies are the major beneficiaries of modern medicine, care has to be taken not to overprescribe. According to a BMC Medicine report, ‘Between 1995 and 2010 the proportion of adults dispensed more than 5 drugs doubled to 20% and the proportion dispensed more than 10 tripled to 6%. The prescription of more than 10 drugs was strongly associated with increasing age. The proportion of potentially drug to drug interactions more than doubled’. At the other end of the scale, however, an Israeli physician Dr Doron Garfinkel demonstrated that by discontinuing 320 drugs in more than a hundred frail nursing-home residents, in the space of a year the numbers dying fell from 45% to 21% and those requiring emergency admission to hospital from 30% to 11%. From this he concluded that polypharmacy was a disease ‘with potentially more complications than the illnesses for which they were prescribed.’
ILL HEALTH IS BIG BUSINESS
The serious flaws in the health system, as revealed by Dr. Le Fanu, are disturbing. It is a national disgrace that the pharmaceutical industry has been allowed to take control of our lives virtually unchallenged.
Where once we were patients, we have now become customers.
Reference: ‘Too Many Pills’ by Dr. James Le Fanu