|
by Jo Waters
November 2, 2010
from
DailyMail Website
Over-prescribing is so rife that
millions of us are given drugs we don't even need, worse, they put
you at risk of stroke, kidney failure and deadly infection...
When your doctor prescribes a drug it means you really need it,
right? Wrong!
In fact, every year, millions of Britons
are given medicine that’s completely unnecessary or inappropriate.
Quite apart from the huge waste this represents for the NHS
(conservatively estimated at £400 million a year), these drugs can
have harmful, even fatal side-effects something the family of
Mary McIlgorm, an 83-year-old from Barrow-in-Furness, in Cumbria,
learned too late.
Mary had suffered with mild indigestion for years, recalls her
daughter Christine, 54, a Post Office clerk.
‘But Mum had always got by with
over-the-counter remedies and it really didn’t bother her too
much,’ she says. ‘Then one day her GP prescribed a drug called
lansoprazole.’
The drugs don't work
Too many people are
being given medication that could do more harm than good
This is one of the proton pump
inhibitor (PPI)
drugs, which work by cutting the amount of stomach acid you produce.
PPIs are used for treating stomach
ulcers and heartburn and have rapidly become one of the most
frequently prescribed groups of drugs. However, studies have shown
that up to 70 per cent of prescriptions for them may be unnecessary.
Mary knew none of this.
‘Mum was instructed to take a pill
every day, but she told me they didn’t seem to be very effective
and she still suffered from indigestion,’ says Christine.
Later that year, when Mary suffered a
fall and broke her arm, she was admitted to hospital. There she
caught
Clostridium difficile, a
superbug that causes severe diarrhea and is potentially fatal. Three
weeks later Mary died.
Christine later learned that PPIs are known to dramatically raise
the risk of contracting C.difficile, some experts believe they are
linked to hundreds of deaths in the UK every year.
‘I was so angry when I found out
about this, especially when Mum probably didn’t need the drug in
the first place,’ says Christine. ‘Her death was completely
avoidable.’
Mary’s experience is far from an
isolated case.
There are as many as 15 groups of drugs
which are over-prescribed, according to guidelines just issued by
the NHS National Prescribing Centre. These include some of the most
commonly used medicines for arthritis, insomnia and asthma. There’s
no denying that these drugs, when correctly prescribed, can
transform patients’ lives for the better.
The worry is when they are doled out
unthinkingly, says Dr Martin Johnson, a former GP and trustee
of the Patients’ Association.
‘Unfortunately, patients can
sometimes end up on drugs they don’t need and these can have
side-effects which impact on quality of life and make them feel
unwell.
Pill popping
Doctors may
prescribe medication, but does the patient really need it?
‘They can also cause long-term
side-effects such as kidney disease or increased stroke risk.
The elderly suffer more because they are more likely to be on
multiple prescription drugs and be more susceptible to
side-effects.’
Indeed, between 16 and 30 per cent of
all hospital admissions in the elderly are caused by inappropriate
prescribing, says Dr Mehool Patel, of University Hospital,
Lewisham, who is the deputy chairman of the British Geriatric
Society’s Council.
‘Increasingly, geriatricians are
seeing elderly patients on lots of different types of drugs they
don’t need.
‘Coping with drug side-effects is a big issue for the elderly.
For instance, many elderly patients are prescribed a drug called
prochlorperazine for dizziness. It’s meant to be a short-term
treatment, but if patients are left on it long term they develop
Parkinsonism - that’s Parkinson’s disease symptoms caused by
drugs.’
Overall GPs in this country are some of
the ‘best prescribers’ in the world, says Peter Rowe, who
runs the Department of Health’s team for assessing medicine use and
procurement.
‘But we can always do better.’
Part of the problem is patients are
often given repeat prescriptions and no one reviews their
medication.
For instance, patients with long‑term heartburn symptoms are meant
to have an annual review of their treatment and helped to reduce or
stop it. In fact, many are not reviewed but left on long-term, high
doses of PPIs.
There needs to be ‘much more
accountability for prescribing’, says Dr Johnson.
‘When I was a GP, I would never have put anyone on a repeat
prescription unless I’d reviewed them to see how they were
getting on and whether the drug was still necessary. That’s just
one simple step to avoid unnecessary prescribing.
‘I think another is for patients to actually ask their doctors
whether they really need a prescription.’
So are your prescription drugs
unnecessary and even harmful? Here, with the help of experts, we
identify the main drugs causing concern . . .
HEARTBURN
The most commonly prescribed drugs for heartburn are PPIs. They are
also used to treat stomach ulcers and to counter the gastric
side-effects of painkilling drugs used to treat arthritis, such as
diclofenac.
Last year alone there were 36 millionprescriptions written for PPIs,
a three-fold increase since 2000.
Not only are these prescriptions often unnecessary, the drugs
dramatically increase the risk of catching potentially fatal
C.difficile, raising your chances by as much as 80 per cent,
according to a review of studies involving 133,000 patients.
It seems PPIs destroy the stomach acid barrier which protects
‘friendly’ gut flora; this allows harmful bacteria to flourish.
The drugs increase the risk of osteoporosis and fractures, possibly
by preventing calcium absorption. PPIs have also been associated
with a 30 per cent increased chance of developing pneumonia in
intensive care.
PPIs may be responsible for hundreds of extra deaths annually, says
Dr Richard Cunningham, consultant microbiologist at Derriford
Hospital.
‘The risk of patients developing
C.difficile is now well-established, but it seems to be taking a
long time for that information to be reflected in prescribing
practice,’ he says.
‘A high proportion of patients admitted to A&E and acute medical
units are on PPIs - up to 40 per cent in some areas - and the
worrying thing is that when many of these patients are
interviewed, most don’t even know when or why they were
prescribed them.’
In fact, research shows only around a
third of patients actually have serious conditions such as peptic
and duodenal ulcers that require this powerful treatment.
‘Doctors are prescribing an
unnecessarily potent drug for mild indigestion when lifestyle
advice or a much simpler drug would be much safer,’ adds Dr
Cunningham.
‘In the past, patients would have been advised to lose weight,
prop up the head of their bed higher (to lessen the chances of
acid coming back up from the stomach) and avoid spicy food, or
at the very most take an over-the-counter antacid treatment.’
Professor Roger Jones, author of
a King’s Fund report, Managing Acute Illness, adds that handing out
reassuring advice on prevention rather than pills can be far more
useful.
‘In some cases prescribing PPIs
became almost a knee-jerk reaction for any patients with
indigestion,’ he says.
‘Doctors often defend their
prescribing by arguing they come under pressure from patients to
give them a prescription, but there’s good research to suggest
doctors tend to overestimate this.
‘Many patients may feel better with a good deal of reassurance
and advice on preventing their problem reoccurring.’
ARTHRITIS
Another group of drugs doled out too readily are those for
arthritis.
The non-steroidal anti inflammatory drugs (NSAIDs)
are some of the most commonly prescribed painkillers in general
practice. However, recent studies have linked them to a higher risk
of ulcers; the drugs stop the body producing chemicals called
prostaglandins, which it needs to
protect the stomach lining.
Doled out
drugs
Arthritis sufferers
are given medicine when exercise could treat the condition too
Meanwhile, diclofenac - the most popular
NSAID - may also raise the risk of stroke. Some experts say the drug
is linked to up to 2,000 extra or premature heart attacks and
strokes a year.
Although prescriptions fell by 5.6 per cent overall between 2005 and
2008, the National Prescribing Centre says the figure remains at a
relatively high level.
Doctors are being urged to review all patients currently prescribed
NSAIDs, and, if painkillers are still thought to be necessary, to
switch patients to less risky forms such as ibuprofen and naproxen.
‘Often other drugs like paracetamol
and codeine may be more suitable if taken at the correct
dosage,’ says Tony Avery, professor of general practice
at the University of Nottingham.
‘It is also very important to consider non-drug treatments. For
example, in patients with osteoarthritis of the knee there are
so many things that can help, including thigh
muscle-strengthening exercises, weight reduction and use of
shockabsorbing shoes or insoles.
INSOMNIA
The worry with the over-prescription of insomnia drugs is that users
can quickly become addicted, which is why doctors are told to
prescribe them for just a few weeks at a time.
There are two groups of insomnia drugs:
-
the
benzodiazepines, which
include diazepam (previously known as Valium)
-
alprazolam (brand name Xanax)
-
and the newer, so-called ‘Z’
drugs - Zolpidem, Zaleplon and Zopiclone
These are all used to treat severe
insomnia and severe anxiety.
The risk of addiction from benzodiazepines has been recognized for
years, and under official guidelines they’re meant to be used only
if insomnia is severe, disabling or causing the patient distress.
Even then, the lowest possible dose that controls symptoms should be
used for a maximum of four weeks, or intermittently if possible.
Although benzodiazepine prescriptions have fallen, an estimated 1.25
million Britons are long-term users; there are around 500,000 people
taking a ‘Z’ drug long term.
Last month, the Earl of Sandwich spoke in the House of Lords to
highlight the dangers of benzodiazepine over-prescription, revealing
a member of his family has been suffering from withdrawal symptoms
for the past 18 months.
He said:
‘These drugs are dangerous. Why do
doctors prescribe them so freely if they provide temporary
relief for so little time and never cure the problem?’
Other potential side-effects of
benzodiazepines include dizziness, memory problems, day time
sleepiness and, in some cases, an increase in anxiety levels.
Withdrawal symptoms can be severe and disabling.
INFECTIONS
Antibiotics are still widely being used to treat viral infections
despite the fact that the drugs have no effect on them at all.
They are prescribed for,
-
81 per cent of otitis media (ear
infections)
-
91 per cent of acute sinusitis
-
60 per cent of sore throats
-
47 per cent of laryngitis
-
even 26 per cent of influenza
cases,
...even though a high proportion of
these illnesses and all cases of flu are caused by viruses.
The concern is largely that the overuse of antibiotics will lead to
more superbugs, resistant to treatment.
But patients have a more immediate reason to want to avoid having
antibiotics, as Professor Avery explains:
‘There’s evidence that they can
increase the patient’s risk of developing resistance to the use
of similar antibiotics in the future, when they may need
treatment for a more serious infection.
‘There is also a major concern - particularly in older people -
that frequent use of broad spectrum antibiotics (which work
against a wide number of bacteria) increases the risks of
C.difficile, which can be fatal.’
Other side-effects from taking
antibiotics include diarrhea, nausea and vomiting.
If you’re treated with broad spectrum antibiotics there is a risk
of developing a fungal infection afterwards, such as thrush.
ASTHMA
High-dose inhaled corticosteroids are often used for asthma, but if
taken at high dosage for long periods they can potentially cause
glaucoma and cataracts, slow growth in children and adolescents and
suppress the adrenal gland (which produces important hormones such
as cortisol).
The British Thoracic Society, recommends the dose is reviewed
every three months, reducing it by 25 to 50 per cent each time.
However, this is not routinely implemented, leaving some patients
over-treated, a report found.
HIGH
CHOLESTEROL
The drug
ezetimibe works by inhibiting
absorption of cholesterol. It cost the NHS £68 million in 2009,
£20 million more than two years previously.
Despite the huge increase in prescriptions, the National Prescribing
Centre says there’s no good evidence the drug reduces the risk of
heart attack or stroke compared to a
statin alone.
Potential side-effects include:
|