One in four adults takes at least three different prescription drugs a week. That includes me, with five items on repeat prescription for the past three years. Am I contributing to the trend for GPs to overprescribe? Critics claim that this overuse of the prescription pad is crippling the NHS financially and could even be shortening our lives.
A distinguished group of senior doctors (the Academy of Medical Royal Colleges) say the vast number of drugs we consume is cause for concern. They want the NHS to wind back from “too much medicine” and replace it with a culture where patients ask “what happens if I do nothing?” and get told the realistic benefits and potential drawbacks of any treatment or procedure.
Medication has reached a shocking level in the UK: the NHS in England dishes out one billion prescriptions a year to half of the population, 2.7 million items every single day. Add to that the cost of blood tests and millions of routine exploratory procedures and you can see how the NHS could be chucking away money it can’t afford.
One reason for this surge in costs is the way the NHS is structured: hospitals receive funds based on the number of procedures they perform, and GPs get rewarded according to the number of people they diagnose and treatments they prescribe. This seems utterly misguided. Surely it encourages patients to expect miracle cures when (a lot of the time) we could be adopting healthier lifestyles and better pain management. Every time we go to the doctors we want a magic bit of paper or another appointment, instead of being more realistic.
It’s time for doctors to say no every time we ask for a pill or a placebo, and we must start asking whether an X-ray or MRI scan, a blood test or a load of physiotherapy is going to make us feel any better than a hot bath, a glass of wine and a cuddle from a close friend. Almost three-quarters of adults aged over 70 take more than three medicines a week (including statins), but are they effective?
Increasingly, critics say this is debatable. Now the debate about unnecessary medication has sparked off a row about whether psychiatric drugs are effective. More than one in 10 women takes antidepressants, almost twice as many as men. Writing in the British Medical Journal, Professor Peter Gotzsche claims that they can cause up to half a million deaths a year in the Western world, and that drug companies routinely overstate the benefits and play down their side effects. He says that in the US, there are 15 times more suicides as a result of these drugs than official statistics show. He wants prescriptions to be given only in acute situations, with a plan in place to taper off consumption, agreed by the patient.
Antibiotics is another area of gross overprescription. No new drugs have been developed for more than 25 years and many are now ineffective against superbugs. This week, the Government’s adviser has announced he would like countries to work together and set up an international fund to pay for the development of new antibiotics, whose usage should be carefully controlled.
Drug addiction, overdoses, and a very brief history of Heroin
Drug addiction, overdoses, and a very brief history of Heroin
1/14 Heroin – the chemical name for which is diacetylmorphine – was originally synthesized by British chemist C.R.Alder Wright (pictured overleaf) in 1874, by adding two acetyl groups to the molecule morphine, which is naturally found in the opium poppy.
2/14 Bayer, the German pharmaceutical company behind Alka-Seltzer and Aspirin, bought the rights to diacetylmorphine, marketing it under the name “Heroin” in 1895 because early testers said that it made them feel “heroisch” or “heroic”.
3/14 By 1898, it was ready for mass marketing. It was originally sold as an over-the-counter cough suppressant that didn’t have problematic side effects, like addiction (the irony) - while alternative treatments morphine and codeine did. This was before they realised that, when taken into the body, it actually converts into morphine, and is ferociously addictive. Thus defeating the object and defining what was to become a historically embarrassing moment for the company in later years.
4/14 By 1899 Bayer was producing a ton of Heroin and exporting the drug to 23 countries, while free samples sent to doctors and studies appeared in medical journals. It was also around this time that early reports of addiction began to surface. The company wisely released Aspirin this year, which would go on to become one of the most popular and widely used pain relief drugs in the world.
5/14 US medicines containing heroin were available over the counter from 1907, after the American Medical Association gave it its stamp of approval.
6/14 As Heroin dependency became a torrent and overdoses began to be reported, Heroin was made illegal to obtain without a prescription from a doctor in the US in 1914. Bayer lost some of its trademark rights to Heroin and Aspirin under the Treaty Of Versailles in 1919, after the German defeat in World War I.
7/14 In the early 1920s, a number of addicted users in New York supported themselves by collecting and selling scrap metal retrieved from industrial dumps. It was from this that the label “junkies” was born. The behavior of Heroin addicts was soon, however, to cause a concern to the public and the authorities. In 1924, it became completely illegal, and doctors were told they could no longer prescribe the drug.
8/14 By this point, Heroin had become popular among creative industries. Pictured left is famed actress Jeanne Eagels, who died of a Heroin overdose in 1929. Its outlawed use had pushed manufacturers underground, and the purity of the product illegal traders now used varied in quality.
9/14 In the UK, the Rolleston Committee Report in 1926, illegal Heroin dealers were prosecuted, but doctors could prescribe diacetylmorphine to users when they were withdrawing from it, if it would cause harm or severe distress to the patient to go without it. This would be the law until 1959 when the number of diacetylmorphine addicts doubled every 16 months between 1959 and 1968.
10/14 The Brain Committee recommended that only selected, specially approved doctors at specialized centres were allowed to prescribe diacetylmorphine to users in 1964. The law was further restricted in 1968, and by the 1970s, the emphasis shifted to encouraging abstinence and the use of substitute methadone.
11/14 In the 1980s, the UK experienced a surge in Heroin supply because of a sudden cheap influx from Pakistan (the main supplier had been – and is now – Afghanistan). Cues from popular culture – and a social downtown caused by the economic and industrial crisis in the late 1970s – created the perfect environment for the Trainspotting generation.
12/14 In the 1990s, Heroin use was again popularized by the rise of grunge and Britpop, while the emergence of ‘the waif’ in fashion, of which Kate Moss is often cited as the originator, would give rise to the term ‘Heroin chic’. In 1994, the Swiss began to trial a diamorphine maintenance program for users who had failed multiple withdrawal programs. It aimed to maintain the health of the user, by discouraging the use of illicit street Heroin. It was deemed a success.
Kate Moss and Johnny Depp, together in 1994
13/14 Today, the largest producer of opium, needed to create Heroin is Afghanistan. This is closely followed by Mexico, who increased their rate of production sixfold between 2007 and 2011. Diacetylmorphine is a controlled, Class A substance in the UK, but continues to be used in palliative care for the treatment of acute pain, such as in severe physical trauma, post-surgical and chronic pain, as well as relieving sufferers of terminal illnesses.
14/14 Key figures continue to campaign for greater sympathies and better treatment of Heroin addicts as they attempt to rehabilitate themselves and re-enter society. Russell Brand’s Give it Up Fund, run in conjunction with Comic Relief, aims to provide financial aid to help people remain free from substance abuse by setting up support groups. "It's integral that people entering a life of abstinence after the chaos of addiction have stability, support and a role to play in the wider community," he said.
It is imperative that doctors stop dishing them out at the current rate. But isn’t it about time that we took responsibility and got our prescription drug use under control? We need to stop using pills to deal with the difficult bits of everyday life.
This no-nonsense parental advice is music to my ears
The other day, a senior family law judge said that it was the job of parents to make children do the things they find boring or difficult, using the “carrot and stick” approach. To get their way, he said, parents should confiscate mobiles and gadgets, enforce curfews and use threats just “short of brute force”. Notice he did not say “have a chat with your kids about how they feel” – how refreshing.
The former BBC Young Musician of the Year, the violinist Nicola Benedetti, also takes a tough line. She points out that maths, science, history and English are all taught without pupils being consulted about content, and she questions why music should be treated differently.
She reckons children do not understand the value of hard work, and thinks studying music should be compulsory. I can’t thank my parents enough for making me learn music from the age of eight and for taking me to concerts. I grew up thinking that all kinds of music (from jazz to classical) were really rewarding. Music removes prejudices and opens your eyes to so many other disciplines. It’s such an important part of my life.
It’s sadly predictable that the Beatles are to be set as a GCSE exam subject. Why does every area of the curriculum have to be made “accessible”? What’s wrong with highbrow?
Let Prince Charles write what he wants
I’ve never been a huge fan of Prince Charles and inherited privilege, and once made a documentary for Sky suggesting that the throne should pass directly to Prince William. But the letters that have just been published have done the Prince an enormous favour.
He emerges as a far more rounded, intelligent individual than his rather dreary eldest son who is so ill at ease in the public arena and who has never exhibited any interest in high culture, architecture or the environment. I’m even beginning to think that Prince Charles’s PR advisers might have orchestrated the long battle to “ban” publication of the letters, knowing all along that when they were published, they would be totally anodyne.
Now David Cameron is planning to create a veto which would prevent confidential memos written by ministers and letters from the Royal Family being published in future. This is scandalous. Prince Charles should be able to write to the Government about whatever he likes – as long as we can read the correspondence.
Although I’m not a fan of his views on modern architecture and his worship of the Neoclassical, his campaign to save many listed buildings is laudable and his concerns about overfishing are in line with celebrities and chefs like Hugh Fearnley-Whittingstall and Jamie Oliver. He’s not such a weirdo after all.
No need to suffer from post-Poldark withdrawal
Call me sexist, but there’s a welcome replacement for Poldark on Thursday nights on BBC2. Tom Hughes is utterly gorgeous as an MI5 operative in The Game, an entertaining Cold War thriller set in 1970s London. The only duff note is Brian Cox, his ringmaster, who sports a bizarre marmalade cat hairdo – orange and silver stripes.
Over here, critics have been sniffy – one called the show “Tinker Tailor Soldier Why?” – but when it was shown in the US last year, The Game was well received.
It’s certainly more entertaining than The Affair (Sky Atlantic), a new series starring Dominic West as a middle-class teacher and novelist who falls for a waitress while on holiday. Their relationship is told from both points of view – a tactic used to greater effect in Gone Girl.
My top television pin-up at the moment is still the wonderfully poignant Peter Kay. He can share my car any day.Reuse content