Today I launched my first annual report as Chief Medical Officer for Scotland . There is an Executive Summary and a short videowhere I introduce the report and its focus on’Realistic Medicine’ and what this can mean for the challenges that face us as a profession and in healthcare.
I believe that the profession, with doctors as collaborative leaders, as in so much of our history, can influence and be a driver for change. My team have produced the infographic below which sets out the questions I want to ask doctors and for them to discuss with each other.
I very much welcome your report. I do believe that over prescribing is a massive problem in general practice and it is not confined to patients with multiple health problems. Please see my website for my campaign on prescribed drug dependence.
Patients are suffering horrendously from benzodiazepine withdrawal. It is not just the issue of being prescribed drugs, it is the issue of the trying to stop them. GPs seem to be unaware of the devastating effects of the drugs they prescribe which is astonishing,
As a patient whose life has been devastated by prescription drugs I do believe it is time for the medical profession and the public to find a better way forward. This debate needs to involve the public as well as the profession. Keeping patients on drugs for decades, risking their health in the process, is not good medicine. canada goose jacket Using the current crisis in general practice is not good enough, this is an issue that has been around for many many years.
I was prescribed nitrazepam for myoclonic epilepsy in 1975. 40 years of depression and antidepressants ensued despite a letter from a neurologist in 1981 stating that nitrazepam could be making my depression worse. I lived a Advised to stop nitrazepam at age 59. Within one year all psychological and emotional problems had gone, nor did I have epilepsy. 40 years of feeling alone simply disappeared. There is no doubt those feelings were due to the drug.
Sadly the withdrawal from nitrazepam has left me bedridden for over two years and I may not recover. I am physically disabled though psychologically well. I am meeting others online from across the UK also severely ill after withdrawing from benzodiazepines. GPs follow the guidelines for withdrawal but these give no warning of the serious consequences that can ensue. My doctors did not recognise the symptoms, did not know what to do. This is not unusual.
I look at the history of benzodiazepine prescribing and realise that despite the 1988 prescribing guidelines stating a 2 4 week limit, these were largely ignored. Untold numbers of patients lives have been ruined. I wonder how this can happen. Presumably doctors clinical freedom is seen as more important than the protection of patients. The addictive properties of the drugs were well documented by the 1980s. Yet even today they are still being given to patients beyond the 2 4 week limit.
I now see that one in four adults in Scotland is prescribed an antidepressant despite the addictive potential of these drugs. Almost everyone I talk to has been offered one and refused, given one and not taken, started taking but stopped and of course some have been taking them for decades. It is clearly not always the patients who want to take these drugs, rather it seems to be the GPs who feel the need to offer them. Yet there is increasing evidence that they do more harm than good. I am now much more aware of how little doctors really know about the medications they prescribe. Yet patients are under the illusion that their knowledge is greater than it really is.
I look back over the years. When I had back pain I was prescribed painkillers which did nothing to solve the problem. An osteopath was able to fix it. For 10 years I suffered daily with the symptoms of IBS. Many pills were prescribed and diets were tried. In the end a chiropractor sorted the whole problem in 6 weeks. My spine was pressing on nerves leading to the gut. So much NHS time wasted, GP visits, tablets and so on and so forth. Surely there has to be a better way forward.
GPs are undoubtedly very busy but they are creating so much work for themselves by making patients more sick than they need to be. Unfortunately many of the side effects of drugs are just treated with more drugs as you know. Patients do not want prescription drugs just for the sake of it, they want to feel well by accessing effective treatment. Those of us who can afford it are happy to pay for non NHS treatments where they exist. it is not helpful that those trained in western medicine ridicule other health care practitioners whose methods are often more effective. I could have avoided 10 years of IBS if only I had known to consult a chiropractor. Better integration of mainstream and complementary therapies would be welcome.
I understand why GPs are encouraged to withdraw patients from benzodiazepines because of the potential risks of falls, cancer, Alzheimer disease etc. However, I wonder why GPs are inadequately trained to deal with prescribed drug dependence as stated by the RCGP in the recent BMA report but at the same time are being encouraged to take patients off the drugs. I also wonder why the SIGN guidelines on polypharmacy which advise on benzodiazepine withdrawal do not prepare GPs for the terrible impact on some patients. The elderly are particularly vulnerable. I have long been a follower of H Gilbert Welsch et al who have been eschewing the dangers of creating patients needlessly in the headlong rush to test and screen.
It is not only the elderly with the increased incidence of polypharmacy who are harmed by this enthusiastic approach but the general public who are continuously encouraged to attend for screening and testing for diseases which will never cause them harm in their lifetimes. The public have been sold the mantra that screening/testing is good and saves lives and it is now time that we caveat this advice with warnings about over diagnosis and over treatment.
The NHS is a finite resource and it is counter productive to direct scarce resources to the well than tackling the health inequalities which exist in our disadvantaged areas.
This is not going to be an easy job as many will perceive this as a exercise few will ask for the evidence on which this advice is based. But I believe the CMO report is a step in the right direction and must be promoted to all health professionals and the public at large. Well done for tackling a very pressing problem.
Congratulations are due to Dr Calderwood for such a comprehensive and forward thinking report.
My petition for improved Thyroid diagnosis and treatment has been ongoing at the Scottish Parliament for over three years. In that time, I have heard nothing but platitudes and affirmations of the status quo from Health Ministers. http://www.51canadagoosereview.top/ The fact that Thyroid Function Tests are based on poor quality evidence seems to trouble no one. Polypharmacy is rampant with thyroid patients and antidepressants are over prescribed, along with a large selection of other drugs, none of which help when the patient needs more thyroid hormones and more choice of thyroid hormones.
Next Tuesday, the Minister for Public Health will attend the committee and I fully expect that she will rhyme off the party line, that the evidence base says this, that there isn enough evidence to do that, that the MHRA in England deal with the other. It helps no one. It fools no one.