Doling out lots of drugs does more harm than good, doctors warned
‘Patients dying needlessly’
‘Benefits overstated’
DOCTORS must avoid prescribing drugs to patients needlessly as it may be causing them harm, according to health experts.
The Academy of Medical Royal Colleges is urging medics to ‘choose wisely’ and not dole out prescriptions or refer patients for tests simply because they feel under obligation.
The academy – which represents 220,000 doctors in the UK – warns a culture of ‘defensive medicine’ and lack of knowledge is leading medics to overdiagnose and overtreat patients.
In guidance issued today, it is urging all doctors to pick five tests or drugs commonly used in their field, and ask themselves whether those things are really necessary. The intervention comes as another senior academic warns half a million Western patients are dying each year because they are needlessly prescribed antidepressants, sleeping pills and antipsychotics used in dementia treatment.
Professor Peter Goetesce, a renowned Danish researcher, said doctors should stop handing out these drugs altogether as their benefits have been ‘overstated’ by pharmaceutical firms and the side effects are ‘immensely harmful’.
NHS figures show more than a billion prescriptions are handed out in England every year – 2.7million a day – and the number has risen by two thirds in a decade. The academy warns that doctors often feel under pressure from patients to ‘do something’ at every appointment.
Its guidance, published in The BMJ, adds: ‘This has resulted in patients sometimes being offered treatments that have only minor benefit and minimal evidence despite the potential for substantial harm and expense.
‘This culture threatens the sustainability of high quality healthcare and stems from defensive medicine, patient pressures, biased reporting in medical journals, com- mercial conflicts of interest, and a lack of understanding of health statistics and risk.’
The academy’s Choosing Wisely programme aims to encourage doctors to question whether certain interventions have any real benefit.
Professor Dame Sue Bailey, chairman of the academy, said: ‘The whole point of Choosing Wisely … is not and will never be about refusing treatment or in any way jeopardising safety. It’s just about taking a grown-up approach to healthcare and being good stewards of the resources we have.’ The academy is urging doctors to give patients more information about the risks of medication. It also wants NHS managers to consider financial rewards for hospitals and health bodies where doctors prescribe fewer drugs.
The BMJ piece cited a recent report by the academy, which argued doctors have an ‘ethical responsibility to reduce this wasted use of clinical resource because … one doctor’s waste is another patient’s delay’.
In another BMJ article, Professor Goetesce, of the Nordic Cochrane Centre, Copenhagen, warns drugs including antidepressants, sleep- ing pills and antipsychotics are causing more than half a million deaths in the Western world a year. His research did not estimate the number of UK deaths but if the trends are applied, there would be about 37,000 annually.
The professor states that the odds of a patient over 65 dying within a year is 3.6 per cent higher if they are on antidepressants.
It is 1 per cent higher if they are taking a benzodiazepine medication – a tranquilliser or sleeping pills – and 1 per cent higher for antipsychotics used for dementia.
These drugs have been linked to heart disease, brain damage, suicide and in the case of antipsychotics, rapid memory decline and early death. Professor Goetesce said ‘biased’ or unfair trials by drug firms ‘overstated’ the benefits and ‘understated’ the number of deaths.
Doctors’ pay is linked to the prescription of particular medicines, such as statins to protect against heart disease. The NHS system pays GPs for performance under the Quality and Outcome Framework, according to doctors writing in The BMJ.
‘The NHS in England has a system of payment by results, which in reality is too often a payment for activity and encourages providers to do more in primary and secondary care,’ wrote Dr Aseem Malhotra, a cardiologist, Professor Terence Stephenson, chairman of the General Medical Council and Professor Sir Muir Gray, from Oxford University.