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OPINION

'Giving people drugs they don’t really need won’t get my vote'

So much for that alternative vote business. What a resounding kicking that took, eh?

It only managed to attract 32% of the votes - that’s one in three of those who voted. Pathetic. I mean it probably would have been enough to become prime minister at the last election - the Tories, after all, secured 36% of the vote.

But that’s different, obviously. Thirty-two per cent is a resounding defeat; 36% a mandate to govern. Nope, definitely nothing wrong with our electoral system.
Not that I was a fan of the alternative vote; it smacked of compromise didn’t it? And anyway, as a friend of mine said: “You can’t win; on the one hand you find yourself agreeing with David Cameron, then with Nick Clegg on the other. Logically they can’t both be wrong but, intuitively, they both most certainly are.” As it is, I think the whole referendum thing struck most people as dull or distracting. We were too busy to worry about constitutional reform and, anyway, we seem to like simple majorities. We like it when the numbers add up.

A recent study has suggested that everyone over 55 ought to be offered drugs to lower cholesterol and blood pressure. The report says age screening for future cardiovascular disease is simpler than current assessments and the age of 55 alone should be the trigger for prescribing. This is a bit like prescribing by a “first past the post” system. It may be that up to 40% of people need drugs but it makes sense to give them to everyone.

The authors also argue that this approach is more cost effective than the current system. They don’t add that it would also offer the pharmaceutical industry a timely boost and, who knows, maybe even lead to some new jobs for pill makers and dispensers everywhere? Anyway, blanket prescribing may really catch on. Antidepressants for everyone over 65 maybe? Anti-obesity drugs for anyone seen buying cake? Botox for the over-40s?

In fact I read this week that scientists have identified a natural supplement made from tomatoes that, if taken daily, could reduce the risk of heart disease and stroke. This supplement will be sold on a high street soon. Or you might just want to eat some tomatoes. That could work too. One wonders if it might make sense to give this supplement out with the drugs? A double whammy if you like. I have no doubt research into this potential marketing opportunity - I mean health benefit - is starting as we speak. Because it is the health of the population we are interested in here, isn’t it? Not new markets. Right?

The idea of generic prescribing raises some interesting philosophical questions. Does it make sense to defer to the public health view that wants to focus on managing disease by managing statistics? If we manage the greatest number in the clearest way, do we do the greatest good? Or, by not individualising our care, do we shift the principles on which we base our work and compromise its quality? And do we belittle the relationship between individuals and their own health by assuming they need drugs?

But it’s not philosophy that informs the modern health service, it’s economics. That which is cost effective is the key policy driver in these austere times and, of course, with every policy idea - as the referendum on the alternative vote reminded us - there are winners and losers. Prescribing by numbers would give at least one overwhelming winner - the pharmaceutical industry. And the losers? Large numbers of people taking drugs that they actually don’t need, maybe?

Readers' comments (7)

  • And the losers? Large numbers of people taking drugs that they actually don’t need, maybe?

    I am fed up with all these articles telling us how we should run our lives and what we should do. sensible advice fine but directives for adults unacceptable and totally distasteful. i refuse to have my health ruined by poor directives. in any case something is advised in the press as valuable to preserving good health one week and discredited the next. worse still there is a sudden vogue for prescribing some medication, often prophylactically, only to find some time down the line that it causes serious side effects - tough for the healthy who have been coerced into taking such stuff. I am a great believer in gathering all the relevant information and then making one's own decisions after careful consideration and not to take what the gp prescribes as gospel. one only has one life and it is up to the individual to preserve it if that is what the wish.

    could any of these directives become compulsory? in which case count me out or be prepared for a fight!

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  • I wonder if this current thinking is based on the recent trend in NNT(number needed to treat) vs NNH (number needed to harm) evaluations of drug therapy. It seems to be leaning on the side of treating the whole population in a particular therapy eg. statins, in order to avoid the acute events eg. MI, where the NNH is minimised (apparently).
    I have profound misgivings with this philosophy, not only from a pharmaceutical coffer filling perspective but from an individualised care and respect perspective. Absolutely right Mark, this is all about economics not care of people.

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  • I don't know, tests cost money and GP's are unwittingly in the front seats to save more money. Will they be pressured to not always cover everything and be able to justify spending so as to treat every patient as they would there own Family?
    I'll take the freebies (if based on quality and not pharma-corporate based research alone) thank you. It seems
    heart attacks, strokes and bowel cancers may have been staved off as a side affect of aspirin, the near natural standard pain killer of choice for generations!

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  • I make my own health and treatment decisions thank you very much and refuse to pump any sort of medication into a healthy over 55 year old body and brain just because marketing, the media or gps dictate.

    all this health advice is really going over the top and preventative medication has dangerous side effects and the investigations serious spin offs. Find one diseased organ, treat it if the NHS can afford it and then die of another disease in another area which has not been investigated or do we all go for a full systems investigation regularly and who would pay for that and any resultant prophylaxis or treatment. isn't it time that the worried well took responsibility for their own health?

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  • I think we should make a distinction here between medication and investigations. I would personally not take any pescribed medication unless the there was clear evidence of need.
    I would however take part in screening programmes for cancer, some of which involve invasive tests. These are usually very infrequent events unlike taking daily medication.

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  • You got it in one Mark. Follow the money I always say and it leads right to the doors of the pharmaceutical companies.
    When I heard that Ed Milliband was elected by AV I made up my mind!

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  • hey an idea!
    give everyone their own insurance.
    stop free at point of care.
    free for poor.
    let them chose what they want.
    eh?
    no of course,the NHS must make decisions,must be free at point of care or the public might get ideas above their station,like chosing to see sucessfull docs,nurses and hospitals instead of the local chop shop.

    and AV worked well at the election-the scottish election which of course uses an AV system.
    and the scottish NHS is in less trouble than the english NHS.
    wonder if there is a connection eh Mark?
    At least you are still thinking outside the box like you used to in the old days(sorry-30 years in nursing now and thank god out of NHS 24 of them-NGO,Army and overseas private)

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