Aseem Malhotra
Dr Aseem Malhotra is an NHS consultant cardiologist and visiting professor of evidence-based medicine, at the Bahiana School of Medicine and Public Health, Brazil
Most patients will derive no health improvement from medication. We should tackle the root causes of disease instead
Our healthcare system has failed to keep to this gold standard of clinical practice for the most important goal of improving patient health outcomes.
The consequences have been devastating. Modern medicine, through over prescription, represents a major threat to public health. Peter Gøtzsche, co–founder of the reputed Cochrane Collaboration, estimates that prescribed medication is the third most common cause of death globally after heart disease and cancer.
In the UK, use of prescription drugs is at an all-time high, with almost half of adults on at least one drug and a quarter on at least three – an increase of 47% in the past decade. It’s instructive to note that life expectancy in the UK has stalled since 2010, the slowdown being one of the most significant in the world’s leading economies.
Contrary to popular belief, the cost of an ageing population in itself is not a threat to the welfare system – an unhealthy ageing population is. A Lancet analysis revealed that if rising life expectancy means years in good health, then health expenditure is expected to increase by only 0.7% of GDP by 2060.
The greatest stress on the NHS comes from managing almost entirely preventable chronic conditions such as heart disease, high blood pressure and type 2 diabetes. Type 2 diabetes alone (demonstrated to be reversible in up to 60% of patients) takes up approximately 10% of the NHS budget. A disturbing report from the British Heart Foundation suggests that heart attacks and strokes are set to “surge” in England over the next 20 years as the prevalence of diabetes continues to increase.
A report commissioned by thinktank the King’s Fund in 2012 recommended putting patient preferences at the heart of decision making in medicine, suggesting it would not just be a victory for ethics and policy but for finance, too, as the data shows patients given all the information choose fewer treatments. But more than saving money, it will be about redistributing resources within the system to where they are needed most, in acute and social care.
This solution to the NHS financial crisis and giving patients the very best chance of improving their health will require a national public health campaign to reduce the amount of medications the population takes, improving lifestyle and adhering to the true principles of evidence-based medicine that make shared decision making the priority in clinical practice.
Source : https://www.theguardian.com/society/2018/aug/30/modern-medicine-major-threat-public-health
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