Belfast Telegraph

Saturday 23 August 2014

Pharmageddon: the prescription pill epidemic

Britain is in the grip of a prescription drug-taking epidemic, with unprecedented numbers of medicines being handed out by GPs, costing billions of pounds and stretching already tight NHS resources to breaking point.

Prescription drug use has increased by 27 per cent in the past the five years and the NHS drug bill topped £10bn in 2006. GPs prescribed 918 million medicines last year compared with 721 million five years ago, according to figures obtained by The Independent on Sunday.

Health experts put rocketing prescription numbers down to medical advances, but also point to poor prescribing by GPs, growing public demand for a " pill for every ill" and aggressive marketing tactics by the pharmaceutical industry, which prompted one MP to warn that the UK is heading towards what he called "pharmageddon".

Paul Flynn, the Labour MP, warned that a failure to change attitudes would be disastrous. He said: "We are heading towards pharmageddon. The medicalising of society is convincing people they need a pill for everything. Drug companies recruit patients, particularly good-looking and articulate ones, to help promote new drugs in the media. Life and death decisions should not be taken by tabloids."

Doctors now write an average of 81 prescriptions a day compared with 64 five years ago. More than 730,000 prescriptions for antidepressants are being handed out each week, to the point where they almost match those for antibiotics at 870,000 a week.

More than £1bn has been wasted in the past five years on buying and disposing of drugs that were never used by patients, according to new research by the Conservative Party. GPs prescribe thousands of drugs patients don't want or take, according to this survey. The money wasted would pay for a year's worth of the breast cancer drug Herceptin for more than 10,000 women or 100,000 cycles of IVF.

Andrew Lansley, the shadow Health Secretary, said: "Every penny wasted is a penny lost to the improvement of NHS treatment. In an NHS that has a postcode lottery on access to NHS drug treatments, surely we must ensure that only those drugs that are really needed and will be used are prescribed. "

News of the wastage comes at a time of growing disquiet at stories of patients being denied access to potentially life-changing drugs on the grounds of cost. Earlier this month, the High Court rejected an appeal by Alzheimer's sufferers for early treatment with a drug they claim helps to slow down the progress of the disease.

The increase in prescriptions will add pressure on GPs to improve their performance. Sir John Bourne, head of the National Audit Office, told the IoS: "If GPs more often followed official guidelines and prescribed generic and other cheaper drugs where suitable, there would be more money to treat patients and pay for expensive or innovative treatments."

GPs aren't 'tuned in' to mental health issues

Doctors are being criticised for overprescribing. Leading psychiatrist Professor Gordon Parker claims that too many people are being wrongly diagnosed with depression and prescribed drugs for perfectly "normal" emotions. Ninety per cent of GPs have said they prescribe antidepressants because there are not enough counselling alternatives, but voluntary organisations that provide such services rarely receive GP referrals. Paul Farmer, chief executive of Mind, said: "Many GPs are not tuned into mental health issues or support services that are available outside the NHS, and what is missing are the mechanisms to make that happen smoothly and effectively. It should be as easy to prescribe a course of counselling as it is to write a prescription."

Defending GPs, however, Professor Mayur Lakhani, chair of the Royal College of GPs, said that the increase should be celebrated as a sign of medical advances. He said: "The argument that society has become medicalised and there is a 'pill for every ill' is an exaggerated one, with no evidence. It is a great time to be a doctor. So much more can be done now. The challenge is for the Government to respond to the aspirations of doctors and patients in saving lives."

But some doctors argue that pressure from growing patient expectations is also behind the increase in prescriptions. Dr Chris Steele, GP and resident doctor on ITV's This Morning, said: "People expect to leave their GP appointment with a prescription in their hand, so if they don't, they are very disappointed. If you tell a patient that you are not prescribing something but want them to do 30 minutes' exercise every day and reduce the fat, sugar and salt content in their diet, a glazed look comes over their eyes and it is like to talking to a brick wall."

Evidence that patients want a "pill for every ill" is supported by the fact that more than 900 million non-prescription or over-the-counter items were also sold last year, and there is growing alarm at the number of people buying drugs from unregulated online pharmacies. Dr Richard Taylor, GP and independent MP for Kidderminster, said: "People now think it is better to take a pill than do something themselves about their own health; for example people want obesity drugs, when the basic thing about obesity is to take exercise and eat only what you need.

"We should be emphasising prevention for every kind of illness, for example, most skin cancers are preventable and a 'statins for all' approach is not helpful at all. Taking money out of treatment to put it into prevention is impossible at the moment; it would need a big change in the current climate. But what needs to be publicised is better self-control."

With 950 drugs currently being developed and no signs of diminishing public expectations, the costs look set to spiral further. Last month Roger Boyle, the Government's heart disease tsar, advocated cholesterol-lowering drugs for every man over 50, arguing that this would save the NHS money in the long term.

Dr Boyle faced criticism for his advice. Critics claimed that his proposal would "medicalise" millions of healthy people and that it failed to recognise that there is no such thing as a risk-free drug. The NHS is not a bottomless pit, they argue, and it has reached a tipping point. The British Medical Association has said for the first time that many health treatments will have to be rationed in the future because the NHS cannot cope with escalating patient demands.

Professor Karol Sikora, a leading cancer specialist, argued that a two-tier system is inevitable. He said: "The NHS is not a bottomless pit. To be fair, it should provide a good core package of cost-effective drugs and the others people should pay for themselves with health insurance. This is an unpopular stance that will not win me any votes, but there is no other solution. The NHS can't provide everything and we need to address this properly."

Some GPs argue that some clinical decisions come down to who shouts the loudest. "It is not possible for the NHS to keep paying for everything. Herceptin makes the front pages, so people with breast cancer get Herceptin, whereas people with Alzheimer's and age-related macular degeneration don't attract the attention, so they miss out," said Dr Taylor.

Marketing of drugs should be seen to be ethical

The pharmaceutical industry also comes in for criticism from those who believe we resort too early to pills. Tony Harrison, a King's Fund associate, said: "The markets are weak, so the drug companies are producing high-cost drugs that don't work very well. The relationship between clinicians and the pharmaceutical industry also needs furthering policing."

A Health Department spokesman said: "More drugs are being prescribed due to advances in medical technology, which means we can treat more conditions. At the same time, it is vital that we have fair prices for drugs and devices, which give value for money to the taxpayer. The Department of Health and the NHS have already put in place a wide range of measures to secure best value for money from the £8bn spent on medicines in primary care and our performance stands up well internationally."

A spokesman for the Association of the British Pharmaceutical Industry said: "We believe it is legitimate for drug companies to market their medicines and provide clinicians with information about them, but it is important that this is seen to be ethical."

Patients' attitudes to their health must change

Health experts maintain that patients themselves need to take more responsibility for their health. The more the NHS spends on drugs the less money there is for preventing diseases. But taking money from cancer drugs to prevent obesity or promote mental well-being would need attitudes to change.

Dr Mark Porter, GP and a BBC health expert, said: "The public owns the NHS, so its first duty must be to provide whatever is demanded by the majority. If that's quick-fix, expensive 'polypills', then so be it. More could be achieved, at a fraction of the price, if people take more personal responsibility and adjusted their lifestyle accordingly."

Patients' views: the best prescription for health

More people than ever are popping pills and the National Health Service cannot keep up. Some people get prescribed life-changing drugs that other people want but do not get. Then there are those who do not want a drug treatment but can't seem to get anything else. As soon as someone hears about a new treatment that might help their condition they want the NHS to pay for it. The situation is complicated but for affected individuals it can mean a matter of life or death, home or hospital.

Kathleen Shaw, 84, lives alone in Bromley, Kent

I am already completely blind in my right eye because of age-related macular degeneration, but when the disease developed in my left eye a new drug was available. My PCT has turned me down due to funding and apparently I don't meet the criteria, but I am going blind. The worst thing is that apart from my eyes I am active woman. I was there at the beginning of the NHS; we put the money in all our working lives so can't they give me something back?

Harriet Loasby, 31, is a part-time student from Hove, East Sussex

I went to see the doctor when I was feeling overwhelmed at university and expected some stress management advice. But I could tell he wasn't listening ... he seemed in a hurry as he prescribed anti-depressants. My mild depression got worse and though I've been prescribed lots of different medications, I've never been offered a psychological therapy by a GP. I can't help wondering if that first doctor had referred me for therapy, the past 10 years could have been very different.

Heather Roberts, 52, from Derby, is married with two children

I was diagnosed with Alzheimer's 18 months ago, I was only 50 and I couldn't believe what was happening to me. Because of my age the doctor prescribed one of the new drugs straight away, and it has given me two years of life back. Before the drug I kept getting lost, I couldn't drive – I was basically withdrawing from the world. Now I can drive and I can make the most of my life. I am horrified that others won't get the same opportunity. Surely everybody deserves a chance.

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