Intended for healthcare professionals


Western medicine: a confidence trick driven by the drug industry?

BMJ 2002; 325 doi: (Published 03 August 2002) Cite this as: BMJ 2002;325:h


Perhaps the BMJ will come on board with the chronic disease
juggernaut which may be the biggest confidence trick. GP are increasingly
prescribing drugs for problems that have no symptoms. Not prescribing them
is seen as negligent. I could suggest the statins, ACE inhibitors for
diabetics and IHD patients with abnormal echocardiograms, all
antihypertensives, aspirin, the newer anti-platelet drugs, and warfarin
for AF. More worryingly these drugs are often started by hospitals who
"cover themselves" by prescribing all possible prophylactic drugs and then
expect the GP to monitor the regime. What happens if the GP decides that
the original reason for the prescription has gone e.g. atypical chest
pain. the patient who reverts to sinus rhythmn. Does he stop the drugs and
take the rap if by chance an event happens after he stops them. No he
colludes in this process by continuing. What does he do with the
increasing number of patients on long term antidepressants. Of course when
they lose their mood lifter, intially they feel worse. And of course
during their two years of prescription they have not be given the chance
to develop non drug strategies for lifting their mood making them more
vulnerable to a "relapse" when they stop the drugs. Is this not akin to
why we do not prescribe anti-obesity drugs.

What effect is this mass prescription of drugs for asymptomatic
conditions and the difficulty of stopping drugs having on the health

In my primary care organisation I calculated the "through the door
workload" which includes any visit to the organisation for any reason
which involves the patient crossing the threshold. Last year we had 62632
compared to the previous year of 44044. My suspicion is that much of this
increase is the crazy out of control chronic disease industry which
requires so much monitoring.

Add in the increasing stringent criteria for diabetes meliitus which
is now being diagnosed in completely asymptomatic patients who have never
had a sugar greater than 10 and this whole process is just going to get
worse. I am sure the next drug will be a glitazone that is shown to
prevent this "mild"(sic) diabetes in at risk individuals.

Perhaps this is all going to result in better health. I am suspicious
that Western mediciine actually makes people less healthy in its chasing
of "good" end points and so we could get the opposite effect. The end
points are good but the process could be highly damaging.

I feel this whole process needs a major debate. Otherwise doctors
will just cover themslves by doing what they are told resulting in most
patients over 60 being on 4-5 tablets at a minimum, having 20 + visits to
the GP per year and 10 + blood tests just to monitor a regime which is
prescribed for condiitons which they are completely unaware of. The empire
builders and the drug industry will head to the bank with a chuckle on
their faces.

Competing interests: No competing interests

03 August 2002
Graeme M Mackenzie
Maryport Cumbria