How too much medicine can kill you | Aseem Malhotra

It’s patients who lose out if doctors and professional journals stop asking the right questions

During a recent clinic consultation, I saw Mary, in her early 60s, with type 2 diabetes. She was concerned that the muscle pains in her legs may have been a result of the cholesterol-lowering statin drug she was taking. “But I’m scared of stopping it.” She explained how a specialist nurse had told her a clot could break off from her aorta, travel to her brain and cause a massive stroke.

I assured her that even in those with established heart disease, who stand to gain most from taking the drug, the risk of death from stopping the medication for two weeks to see if the side-effects would go was close to 1 in 10,000 .

Unfortunately, such misinformation and fear-mongering is common. One of the root causes is undoubtedly driven by the commercial interests of the pharmaceutical industry.

As cardiologist Peter Wilmshurst points out in a talk he gave at the Centre for Evidence-Based Medicine last year, the drug and device industry has an ethical and legal responsibility to produce profit for their shareholders but not to sell patients and doctors the best treatment. But the real scandal, he says, is the failure of regulators and the collusion of sorts between doctors, institutions and medical journals.

According to Peter Gøtzsche, professor of research design and analysis at the University of Copenhagen, prescription drugs are the third most common cause of death after heart disease and cancer. In an analysis published in the BMJ, he estimated that every year psychiatric drugs, including anti–depressants and dementia drugs, are responsible for half-a-million deaths in those aged over 65.

Between 2007 and 2012, the majority of the largest 10 pharmaceutical companies all paid considerable fines for various misdemeanours that included marketing drugs for off-label uses, misrepresentation of research results and hiding data on harms. But as long as these criminal acts generate profit, they will continue unabated.

Medical journals and the media can also be manipulated to serve not only as marketing vehicles for the industry, but also be complicit in silencing those who call for more independent scrutiny of scientific data.

Earlier this year, the editor of the Lancet, Richard Horton, wrote that possibly half of the published medical literature may simply be untrue and that science had “taken a turn towards darkness”.

It is therefore welcome news that several weeks ago Britain’s chief medical officer, Dame Sally Davies, called for an inquiry into the safety of medicines to restore the public’s trust. But what is disappointing is that she has asked the Academy of Medical Sciences to carry out the review. As one respected senior academic, who did not wish to be named, told me, it was “hardly independent” and it was akin to asking “foxes to guard the hen coop”. And it’s worth noting that the academy has not signed up to the AllTrials campaign started by Ben Goldacre, which calls for all results of all clinical trials to be made available to doctors, researchers and patients.

But real political will to address these issues has also been lacking. Rather than pursuing his current obsession with new contracts, the health secretary, Jeremy Hunt, would be doing doctors and the British public a far greater service by choosing to attack the manipulations and excesses of vested interests contributing to an inefficient health service.

In July, Sir Bruce Keogh, former cardiac surgeon and medical director of NHS England, said that as many as 10-15% of medical and surgical treatments in the NHS should not have been carried out on patients.

This comes only a month after the Academy of Medical Royal Colleges, the independent organisation representing the UK’s 220,000 doctors, launched a campaign to reduce the harms of too much medicine, stating commercial conflicts of interest, defensive medicine and biased reporting in medical journals as root causes.

One of the academy’s recommendations asks for commissioners to consider different payment incentives for doctors that focus on providing quality care by having sensible conversations with patients about the value of a treatment. Better this than one incentivised by the volume of drug prescriptions or number of operations undertaken.

Professor Chris Ham, chief executive of health thinktank the King’s Fund, says: “Many doctors aspire to excellence in diagnosing disease; far fewer unfortunately aspire to the same standards of excellence in diagnosing what patients want.” And he’s absolutely right.

Three months later, Mary feels like a “new woman” after her muscle pains disappeared within a week of stopping her statins and her quality of life is now much improved, tolerating a lower dose of the drug. She also began following a high-fat Mediterranean diet that was low in sugar and other refined carbs after I told her it would be more effective than any pill we could give her to reduce her risk of heart attack or stroke. She has already lost weight and even her type 2 diabetes is better controlled.

Corporate greed and systematic political failure have brought healthcare to its knees. There are too many misinformed doctors and misinformed patients. It’s time for greater transparency and stronger accountability, so that doctors and nurses can provide the best quality care for the most important person in the consultation room – the patient. As John Adams, the second US president, said: “The preservation of the means of knowledge amongst the lowest ranks is of more importance to the public than all the property of all the rich men in the country.” It’s time to restrain the harms of too much medicine.

Aseem Malhotra is a London-based cardiologist


Aseem Malhotra

The GuardianTramp

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