The latest issue of the Health Survey for England provides data on the use of prescribed medicines by people living in the community, which therefore relate to the general population and not just those within the healthcare system. The results are based on information supplied by the individuals themselves rather than the agencies responsible for prescribing or dispensing.
It was found that:
- 43% of men and 50% of women surveyed reported that they had taken at least one prescribed medicine in the last week.
- 22% of men and 24% of women reported that they had taken at least three prescribed medicines in the last week. . This proportion increased with age but did not vary by sex.
- The proportion of participants who reported that they had taken at least one prescribed medicine in the last week increased with decreasing income, increasing area deprivation (measured by Index of Multiple Deprivation), and body mass index (BMI).
- Almost all participants aged 65 and over who needed help with activities of daily living (social care) were taking at least one prescribed medicine and most of them were
taking at least three.
In England, the total costs of medicines during 2013 was over £15B. There were over one billion prescription items dispensed which is equivalent to 2.7 million per day. 307 million (30%) were for cardiovascular disease of which 65 million were for hypertension, heart failure and lipid lowering. On average 18.7 prescription items were dispensed per head of population in England in 2013. The largest single category was for the treatment of diabetes which accounted for almost 10% of the total cost.
This information, which is being made available for the first time, raises a number of issues and questions.
Can this enormous usage of prescription drugs be justified? Although we have the information on the costs incurred, what exactly are the benefits? It is also vital to have an appreciation of the possible adverse side-effects which may be caused by the use of these drugs.
Despite the widespread belief that all drugs are beneficial to everyone who is treated, the reality is very different. A very useful piece of information is the Number Needed to Treat (NNT). This is the number which have to be treated for one person to benefit. The NNT website provides the figures for a number of commonly used medicines. Here are some examples:
- For anti-hypertensive treatment for the primary prevention of cardiovascular events in mild hypertension it was concluded that no patients derived any benefit but 1 in12 were actually harmed (2). It is somewhat alarming to learn that in one of the trials used in this evaluation more women died amongst those being treated than in the group on the placebo.
- When beta blockers are used to treat an acute heart attack (myocardial infarction) it was found that none were helped but 1 in 91 suffered from cardiogenic shock (3).
- The use of aspirin to treat for a heart attack found that 1 in 42 derived a benefit (life saved) but 1 in 167 were harmed by non-dangerous bleeding (4).
- Neuraminidase inhibitors are used to prevent influenza. However the evidence shows that none were helped in the sense that an influenza-like illness was prevented. But it was noted that if the drug is used as a treatment for acute influenza there is an average of about 1 day of symptom relief. Unfortunately this only applies to those with proven influenza infection who take the drug within 48 hours of the first symptom. On the other hand 1 in 7 experienced nausea and 1 in 37 were harmed by vomiting (5).
- When insulin is used to control blood glucose in acute ischaemic stroke it was found that none were helped and 1 in 7 were harmed (6).
In view of all the controversy it is interesting to look at the information on statins:
- Using statins to treat for acute coronary syndrome it was found that no-one derived any benefit (life saved; heart attack, stroke, or heart failure prevented) but an unknown number were harmed (medication side effects/adverse reactions) (7).
- When statins were given for 5 years in order to prevent heart disease in those who already suffer from it the evaluation showed that 1 in 83 were helped (life saved), 1 in 39 were helped (preventing non-fatal heart attack) and 1 in 125 were helped (preventing stroke). However 1 in 50 were harmed by developing diabetes and 1 in 10 experienced muscle damage (8).
- When statins were given for 5 years to prevent in heart disease in those did not have a history of heart disease, there were no lives saved although 1 in 60 were helped by preventing a heart attack and 1 in 268 would have avoided a stroke. On the other hand the adverse effects were same as above with 1 in 50 likely to have diabetes and 1 in 10 muscle damage (9).
And so it goes on. It is blindingly obvious that the effectiveness of drugs is much less than most people actually perceive and certainly does not comply with the image presented by their promotion and marketing. The reality is that when a drug is recommended or prescribed the patient involved expects quite reasonably that there is a strong possibility that he/she personally will benefit. The hard reality is that if a person has a life threatening illness, even a very low chance of success would be seized. But I wonder how many are aware just how poor the success rate is for many drugs? What is even worse is that the NNT shows that for lots of drugs “none were helped”! With prevention we have a totally different scene where people generally are being treated with little chance of any benefit. In addition they are also required to accept the possibility of experiencing side-effects which may be quite nasty. Multiple prescriptions mean that many of the drugs are used in combinations. The harsh reality is that our knowledge of such interactions is minimal and therefore we have little idea of any dangers to health which might arise.
In the light of this information, there can be little doubt that most of the drugs which are being prescribed have little beneficial effects for the vast majority of people who are treated with them. I find it absolutely astounding that for many of the drugs in use today the NNT reviewers concluded that none of those treated had any improvement in health. There can be no justification for continuing the use of such drugs. When the likelihood of adverse side-effects is taken into consideration, it is quite unbelievable that people are still being treated with them. To cap it all, a substantial proportion of the total health care expenditure is on drugs. It is obvious that much of this cannot be justified and is effectively a waste of resources, which could otherwise be used to employ additional staff who would actually care for patients.
This latest information is extremely revealing and worrying. A huge amounts of money is being spent on drugs that make little contribution to improving health and are probably doing more harm than good.
It beggars belief that although many parts of the NHS are being squeezed financially the expenditure on drugs appears to escape scrutiny, even though there is solid evidence that there is considerable scope for saving resources by ceasing to buy those which do little to improve health.