Prescription rates in England - a bitter pill?
Shock horror! Half of Britons take drugs every day! From the headlines in the media on yesterday's publication of the Health Survey for England's findings, I thought the survey showed that one in two adults were smoking marijuana behind the bike sheds. In fact, the survey showed that 43% of men and 50% of women were taking at least one regular prescription medicine. In interview after interview, I was asked 'does this mean doctors are over-medicating us?'
The answer is yes and no - I'm prescribing more medicines than I would in an ideal world, but I don't feel I have any choice. Most of the drugs are preventive medications, designed to stop heart attacks and strokes. Thirty per cent of prescriptions issued were for cardiovascular disease - the most common prescription issued in England last year was the cholesterol-lowering drug simvastatin, with 40 million prescriptions. Next came aspirin, with 31 million. Some of these medicines are used for people who have already suffered a heart attack or stroke, but most are for people identified by blood pressure and cholesterol checks as being at high risk.
I'm certainly prescribing more of these than I would like to - because if people lived healthier lives some of them at least wouldn't need them. But all too often my patients tell me it's 'too hard' to tackle their diet or weight, to give up smoking or to exercise regularly. When their risk factors stack up, I have no choice but to recommend medications if I want to lower their risks.
Life expectancy in the UK has increased by about two years every decade for the past 50 years. We have more than halved death rates for cardiovascular disease in the last few decades. But sadly, it's not due to healthy living - while smoking levels have dropped impressively (from 45% of adults in 1974 to about 20% today), other risk factors, like obesity,type 2 diabetes and lack of exercise have all risen. Prescriptions to treat diabetes now account for almost 10% of the cost of all prescriptions in England, and while type 1 diabetes has nothing to do with lifestyle, type 2 diabetes most definitely does.
Of course, it's not just the risk of heart disease that rises with age. Other medical conditions, like osteoarthritis, atrial fibrillation and chronic obstructive pulmonary disease (COPD) also get more common - and as the population ages with every passing decade, more and more people need medications to treat these conditions. Among 45-54 year olds, 42% of men and 50 % of women are taking at least three medicines a week. Over 80% of 65-74 year olds of both sexes are taking three.
The biggest question, perhaps, about whether doctors are prescribing too much comes from antidepressants - one in 10 women is taking them. Depression does affect twice as many women as men, but tablets certainly aren't the only answer. Talking therapy like cognitive behavioural therapy often provides more longer lasting benefits - but waiting lists are often long and doctors may want to offer a 'quicker fix'. In more severe depression, a combination of tablets and counselling is often needed.
Taking depression out of the equation, are so many drugs a bad thing? They're certainly keeping us alive longer, but so would a healthier lifestyle, which can reduce the risk of cancer and osteoarthritis, as well as cardiovascular disease and type 2 diabetes. And unlike drugs, with a healthier diet and more regular exercise, we don't need to read the patient information leaflet for side effects.