Head To Head

Should action take priority over further research on public health?

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k292 (Published 01 February 2018) Cite this as: BMJ 2018;360:k292

Re: Should action take priority over further research on public health?

Capewell and Cairney, in their ‘Yes’ argument say that ‘A delayed response to evidence can be damaging’ and that ‘when scientists refer to “insufficient evidence” they may naively help opponents of policy change, including vested interests. They also argue that “Insufficient evidence” is an excuse for dither and deaths.

In March 2014 – four years ago - the BMA Board of Science carried out research into ‘Prescribed drugs associated with dependence and withdrawal’. The results of this research were formally published 18 months later, October 2015 (1) . There followed stakeholder meetings hosted by the BMA and follow-up. In October 2016 the BMA announced a formal call for ‘better support systems for patients suffering because of dependence or withdrawal’ stating that ‘In the absence of robust data, we do not know the true scale and extent of the problem across the UK. However the evidence and insight presented to us by many charity and support groups shows that it is substantial. It shows us that the 'lived experience' of patients using these medications is too often associated with devastating health and social harms.’(2)

Public Health England has very recently announced that it will carry out a ‘public-health focused review of commonly prescribed medicines, authorised for adults who have non-cancer pain, anxiety, insomnia or depression’ (3). This review is planned to take place over 2018 and to report in early 2019, so will be 5 years from the time that the BMA Board of Science research evidence was collected and indicated alarming issues with these prescribed medicines..

Meanwhile countless patients have been, and continue to be, harmed and disabled by these prescribed drugs, affecting lives, families and society and contributing to poverty and deprivation. Many patients have suffered terribly and died prematurely.

Cases of ‘medically unexplained’ illness and disability are rising inexorably. The evidence is clear, if only we look and take notice.

The All Party Parliamentary Group for Prescription Drug Dependence, and previously APPGITA, have been calling for action on these issues for many years.

Patients in Scotland and Wales (4) are in the process of petitioning their respective parliaments and calling for action. Individual patients are providing the clearest evidence of what has happened and is happening: being disbelieved and dismissed by their doctors when they are suffering serious harm by medicines ‘taken as prescribed’. Powerful and harrowing written evidence is in the process of being sumitted and published on the webpage of the Scottish Parliament Public Petitions, reference PE01651 (5).

At the recent Committee evidence session at the Scottish Parliament (18 January 2018) the Principal Medical Officer and the Minister for Mental Health Scotland stated that they did not ‘recognise’ the premise of the petition: ‘that there are people who were not given proper advice about the consequences of taking these prescriptions, put on those drugs, not given other supports and left on them; also that the GP does not know how to support them through the withdrawal of the drugs’. They conceded only that the petitioner ‘felt’ that there is an issue.

It would seem that the behaviour changes referred to by Aileen Clarke as being needed ‘to improve the public health of our patients, families, and communities' are actually at the level of medical advisers to politicians and influential members of the medical profession and institutions - who are clearly very powerfully wedded to their own beliefs.

The evidence is clear.

(1) http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a23_1/apache_medi...
(2) https://www.bma.org.uk/collective-voice/policy-and-research/public-and-p...
(3) https://www.gov.uk/government/news/prescribed-medicines-that-may-cause-d...
(4) http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=19952
(5) http://www.parliament.scot/GettingInvolved/Petitions/PE01651

Competing interests: No competing interests

05 February 2018
Marion Brown
Psychotherapist and Mediator (Independent)
none
Helensburgh, Scotland