Intended for healthcare professionals

Views And Reviews Provocations

Mass medicalisation is an iatrogenic catastrophe

BMJ 2018; 361 doi: (Published 28 June 2018) Cite this as: BMJ 2018;361:k2794
  1. James Le Fanu, retired GP and journalist
  1. james.lefanu{at}

Profligate prescribing has brought a hidden epidemic of side effects and no benefit to most individuals, says James Le Fanu

“Tis impossible to separate the chance of good from the risk of ill,” wrote David Hume presciently, anticipating, by 250 years, medicine’s current existential crisis. There is no drug or procedure with its “chance of good” that may not harm some. The more doctors do, the greater that risk. And doctors are certainly doing much more with, over the past 20 years, a dizzying fourfold rise in prescriptions for diabetes treatments, sevenfold for antihypertensives, and 20-fold for the cholesterol lowering statins.12 Meanwhile the number of people taking five or more different drugs has quadrupled to include almost half of those aged 65 or over.3

And “the risk of ill” from this massive upswing in prescribing? A hidden epidemic of immiserating symptoms such as fatigue, muscular aches and pains, insomnia, and general decrepitude,4 a 75% rise in emergency admissions to hospital for adverse drug reactions (an additional 30 000 a year),5 and almost certainly a contributory factor …

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