Intended for healthcare professionals


A prescription for better prescribing

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:459

Re: ... and poor prescribing is continual

To a layman, the problem is not so much poor prescribing as poor
choice of substances to prescribe which will cure the fundamental
deficiencies rather than "poke rather blunt drug sticks into the works of
the body"

Who, having motor car problems, would ever employ again a mechanic
who dived into the works of the engine to alter fundamentals, like valve
timing, fuel access to one or more cylinders, or accelerator pedal travel,
before taking more than a cursory glance at fuel, oil, water, battery
charge, tyre pressure, etc beforehand. Yet the Formulary is filled with
blockers, inhibitors, antagonists, lowering drugs, and the levels of the
very many factors important to the proper working of the "machine" are not
sufficiently measured or understood, neither are supplementary factors
necessary to correct them available.

During the last 50 years or so, there have been great discoveries in
the field of metabolism, bioenergetics, and individual cell biology, but
as the substances involved are natural body products they are not
patentable and so of no interest to the drug manufacturers, and not
proclaimed to all by over persuasive drug reps (see for a former drug rep's story
and, doctor, beware!!) In fact, everything possible appears to have been
done to attempt to divert attention away from them.

Take, for instance, the NORVIT trial to assess the virtues of a
combination of cheap B vitamins to lower homocysteine, a much more
strongly implicated substance than cholesterol in the fight against heart
disease. Who, in their right mind, would assemble groups of candidates for
a trial who had all had heart attacks, and 90% of both treatment and
placebo groups were taking statin drugs. The one feature of statins that
really works is the side effect of homocysteine inhibition, so it was only
to be expected that no extra benefit ensued and that the opposition crowed
loudly at the result.

Suspicion of incompetence or rigging has been evident in other large
trials on which prescribing policy has been based. More than "Peer
approval" is needed, and a thorough and independant audit on the totality
of the methods used and of the conclusions drawn should always take place
before the trial subjects are thrust upon the public by Government
Guidelines and edicts.

Coenzyme Q10 is the most important substance overlooked by mainstream
pharmacology, its reduction over the lifetime being the most likely cause
of ageing, as all components of the body deteriorate without the access
which it provides to energy, it has been found to alleviate many
illnesses, even heart failure in many cases, and so becomes the enemy of
those who wish to sell "interference" type drugs.

Carnitine is another, necessary for the metabolism of fat in muscle,
including heart muscle, very useful in alleviating Carnitine deficiency in
Post Polio Syndrome and used by hundreds in Australia and elsewhere where
the news has spread. Virtually unknown here, I met an elderly polio
survivor yesterday, and discussed his problems, I am sure carnitine would
help him as it has helped me, but, as it is not available on the NHS, I
doubt whether, as a pensioner, he would be able to afford it. It is also
effective in relieving statin damage muscle pain.

So what is the answer? with the tentacles of financial backers having
overwhelming influence at all levels, nothing will be easy. Only a root
and branch restructuring of research, study and trial financing, with a
move into the public sector, can hope to put the patient's welfare really
at the top of the competing interests involved.

Competing interests:
Solely as a badly damaged statin victim

Competing interests: No competing interests

28 September 2006
Raymond G Holder
Retired engineer