No one knows precisely how many people are killed every year by doctors

Not surprisingly, the medical profession isn't too keen on sharing that sort of information with patients.

This is partly because they don't want to scare too many people away by broadcasting the truth. After all, orthodox medicine is, these days, in close competition with many varieties of alternative medicine and doctors are only too well aware that their safety record is considerably worse than any of the competitors.

But this shyness is also a result of a perhaps understandable reluctance to share information that could lead to doctors spending even more of their time in court than they do at the moment.

As I showed in my book 'Betrayal of Trust' (also published by the European Medical Journal) one in six patients who are in hospital are there because they have been made ill by a doctor. This figure is, if anything, an under-estimate. Given half a chance most doctors will write 'cardiac failure' or 'pneumonia' on the death certificate rather than the possibly more honest 'medical cockup'.

Most of the world's medical profession studiously ignored the revelations in 'Betrayal of Trust', despite the importance of the evidence and the fact that I was claiming - and substantiating - that, on balance, doctors now do more harm than good and are as important a cause of illness and death as heart disease and cancer.

I don't think any doctor has ever disputed my claim that one in six patients in hospital are there because they have been made ill by doctors. But many doctors seemed unhappy about the fact that I was saying it in public. A not uncommon complaint was that I was bringing the profession into disrepute by giving the public this sort of information. I felt the implication was that the world would be better served if I would shut up, go away and let the people who know best (the medical profession) look after things.

Doctors do not kill patients (nor even make them ill) because they are particularly evil, mean spirited or psychopathic. Most doctors are quite decent people. Their motives are honest enough; they want to make a good living doing a useful job. There are evil, mean spirited and psychopathic doctors around, of course. But no more than you would find among accountants, solicitors or estate agents.

Doctors kill patients (and make them ill) for two main reasons. The first is that many are, generally speaking, professionally incompetent.

The interview is the most important part of the doctors diagnostic equipment. That's when he talks to the patient and - even more important than talking, though you wouldn't think so if you sat in on the average out patients' clinic - listens to what the patient has to say. It is by talking and listening to patients that doctors learn most.

Over the years doctors have accumulated more and more equipment. But, instead of helping, the equipment has come between the doctor and the patient. Too often the doctor relies exclusively on his equipment; trusting it implicitly to provide him with the right answers. And all too often the result is that he produces an ill fitting off the peg diagnosis rather than a bespoke diagnosis which can lead to appropriate and effective treatment.

The first piece of equipment that doctors acquired was the stethoscope. This now symbolic device was invented so that doctors could listen to their patients' chests without having to put their heads down on their bosoms. The stethoscope added to the doctor's dignity. But it also provided the first mechanical barrier between doctor and patient. And since Ren‚ Laennec first introduced the stethoscope the doctor patient relationship has been weakened and damaged by this obsession with equipment, and this failure to respect the relationship between doctor and patient.

A few years ago an American study showed that one person in ten who had died would have still been alive if the doctors looking after them had relied upon their heads instead of their equipment.

One problem is the fact that the equipment doesn't allow for individual eccentricities - and the reality that your body might be slightly different to mine.

Things are made even worse by the fact that equipment often breaks down and is frequently badly maintained. Shops have to have their scales calibrated but ask your doctor when he last had his blood pressure machine calibrated and watch him blush.

Can you think of any reason why the thousands of pieces of equipment which are supplied to hospitals should be any more reliable than the equipment you buy for the kitchen? I believe that as much as half of the new equipment being delivered to hospitals could be defective.

If that doesn't worry you then the fact that many of the doctors who are responsible for using the equipment don't know how it works, how it should be calibrated or how to tell if it is working properly, should worry you.

The second reason why doctors kill so many people is that they are politically innocent and commercially inept and nowhere near as bright or as street-wise as they would like the rest of the world to think they are.

Through a mixture of ignorance and stupidity they do not realise that the profession of which they are, largely, proud members has been sold to the pharmaceutical industry by the international medical establishment.

Whether the medical profession has sold out to the pharmaceutical industry because it is populated by greedy, grasping and unscrupulous men and women or because it is full of individuals who are politically innocent and commercially inept I have not yet decided. My suspicion is that doctors around the world are so full of their own self importance and so out of touch with reality that they do not even realise that they have been bought and are now controlled by the world's most unscrupulous industry.

Back in the middle ages people were reluctant to go into hospital. They knew that they were unlikely to get out alive. Those patients who survived the incompetent ministrations of doctors and nurses were likely to die of infections contracted on the ward.

Things didn't get much better until well into this century when the discovery of anaesthetics, antiseptics and antibiotics gradually meant that patients going into hospital had a reasonable chance of benefiting from the experience.

But the good days are now over. Modern medicine has again become a major hazard. And doctors are again one of the most significant causes of death and ill health.

Amazingly, I believe the evidence available proves that doctors cause as much serious illness as cancer or heart disease. One in six patients in hospital are there because they have been made ill by doctors. The inescapable conclusion is that today's doctors and nurses should carry a health hazard warning stamped on their foreheads. Each hospital should have a health warning notice hung over its entrance.

Politicians must undoubtedly take some of the blame for this disastrous state of affairs.It is, after all, they who have handed over control of our hospitals to an ever growing and increasingly incompetent bureaucracy.

In many countries both the number of nurses working in hospitals and the number of beds available for patients have been falling steadily for years. But at the same time the number of administrators employed has been rising remorselessly. Wards are closed down or lie unused and empty while administrators spend essential funds which could be used for looking after patients on wall to wall carpeting, exotic pot plants and weekend conferences in expensive locations. Changing a light bulb costs a small fortune in administrative costs and it can take so long to persuade five administrators to send along one electrician that I've known nurses take in their own light bulbs and surreptitiously change them themselves. It is so much quicker and easier than filling in all the necessary forms.

We can blame the administrators for failing to administer hospitals and healthcare properly but we must blame the politicians for giving them the power they are now abusing.

But although the politicians and the administrators waste money and resources, and have undoubtedly weakened health services, it isn't solely their fault that doctors and hospitals now do more harm than good. Orthodox medicine has become a menace to patients because the medical establishment has sold itself - body and soul - to the drug industry.

If you're naive and innocent you probably imagine that when a doctor decides to prescribe a drug for you he selects a product which independent research has shown to be most effective for your condition.

He doesn't. Most doctors probably wouldn't know what to do with independent research if they saw it. When the doctor reaches for his pen and his pad he writes out a prescription for a drug about which he knows only what he has been told by the drug company's representative or what he has read in the drug company's advertisements.

The savage truth is that medicine is no longer a profession. Today's doctors are merely a marketing arm of the pharmaceutical industry. Doctors, once a responsible and respectable group of men and women, have sold their souls for an endless supply of free meals, free pens and free golf balls.

When it comes to honest and reliable advertising the drug companies come a long way after second hand car salesmen. The drug companies - and their vastly overpaid executives - will do anything to make money. These people are so ruthless that they make the Colombian drug barons look like boy scouts. Much of the stuff doctors prescribe is complete rubbish. Most of it has never been shown to be either safe or effective. Drug companies test the stuff they sell on animals (proven to be entirely useless for predicting what will happen when pills are given to people) and then ruthlessly use the sort of techniques usually employed to sell shampoo, cigarettes, cars and perfume to naive and innocent punters to persuade doctors to contribute to their profits.

As a final insult to the patient, if politicians dare to hint that they are unhappy about paying inflated prices for pharmaceutical junk that doesn't work, the pharmaceutical companies simply threaten to take their pill producing factories and their massive profits off to some other country where the politicians know enough to treat drug company executives with the respect they require.

Politicians, bureaucrats and doctors have put health care back into the middle ages.

The purpose of this book is simple: to encourage you to be sceptical of your doctor, to teach you what to watch out for (and how your doctor may make you ill) and to show you how to stay healthy so that you will be less likely to need to come into contact with any health care professional!

I have been a passionate advocate of patient consumerism for two decades and the pages which follow are packed with advice and tips on how you can live a longer, healthier life - and protect yourself from an increasingly incompetent and dangerous medical profession. Apart from being aware of the threat to your health that your doctor poses (and if you want to stay alive and healthy you should treat all doctors and other health professionals with a considerable amount of suspicion) you should learn to take control of your own life as much as possible. You should learn to be independent and sceptical. You should ask the right questions (this book will tell you the questions to ask) and, most crucial of all, retain overall responsibility for your health. You should know what to watch out for when taking drugs (this book will tell you what to watch out for) and you should know how to be an independent, sceptical consumer. And you should know how to use - and get the best out of - doctors and hospitals when you do need them.

Vernon Coleman, 1996

1. Don't Let Your Doctor Bully You
Doctors used to be trusted and respected by their patients. But, sadly, that's not always true these days.

Gradually, doctors have become more and more unpopular. I don't think this has got anything to do with the treatments doctors offer - or with the effectiveness or otherwise of their cures. I think that the reason is much simpler. Doctors are unpopular today because they are offhand, patronising and bloody rude! They treat patients without respect and bully them into submission.

Every day I get letters from patients who have been treated like dirt when they've dared to ask questions or speak out of turn.

'I was in tears when I left the hospital,' complained one reader. 'The consultant kept me waiting for three hours then hardly spoke to me. When he'd finished poking and prodding he just walked away. A nurse came and told me I could leave. My husband, who was waiting outside for me wanted to go in and punch him. I still don't know what's wrong with me.'

I sometimes feel ashamed to be a member of the medical profession.

'I was taken into a cold examination room and told to take off all my clothes and lie on a couch,' wrote another patient. 'I was left there, naked, for 25 minutes. I was sitting on the couch hugging my knees to keep warm when the consultant, a nurse and a trail of medical students burst into the room. The doctor then gave me an internal examination with everyone staring. No one took any notice of me or spoke to me. When they'd finished they just left.'

It is hardly surprising that millions of patients are seeking help from alternative medicine practitioners. The truth is that most patients don't desert orthodox doctors because they are looking for better treatments. Most are attracted by alternative medicine because they think it's their only chance of being treated with any respect. And much of the time they're right!

Family doctors (GPs) aren't innocent when it comes to being rude but hospital consultants are by far the worst offenders. Many behave as though they think they are gods. They treat nursing and junior staff like slaves and treat patients with undisguised contempt. Too often hospital consultants act like prison camp guards in Siberia and treat patients as though they are prisoners who've offended the State. Medicine is supposed to be a caring profession but every week thousands of patients make complaints about doctors who have been arrogant, rude and distinctly uncaring.

Here's another letter from a reader:

'When the consultant had finished with me I felt like a piece of meat. As though I was a cow being herded from one place to another. As though I had no feelings and no intellect. I wasn't given the chance to ask any questions. I was so upset that I couldn't get the bus and had to be fetched by a friend. It was a nightmare!'

Doctors often seem to forget that although they may become blas‚ about death and illness every medical consultation is - to the patient involved - a significant and memorable event.

Many patients complain that hospital consultants show off in front of junior doctors and nurses. (The same doctors are usually said to be polite - even ingratiating - with their private patients). And bad manners are catching - and imitated by nurses, junior doctors and others. I've received thousands of letters from readers complaining about rudeness displayed by nurses, auxiliaries, orderlies, physiotherapists and radiographers. Night nurses seem to annoy more people than any other group. Some hospital staff seem to enjoy humiliating and de-humanising their patients. Pregnant women and the elderly often seem to be treated with least kindness.

Here are more extracts from reader's letters:

Mr A : 'When I told my consultant that I would go mad if I had to put up with my symptoms any longer he said: 'You probably already are, my dear!' He was playing to the gallery and laughing when he said this and his entourage laughed politely to please him.'

Mrs B : 'A consultant showed off to impress younger colleagues. When I murmured a complaint he said: 'No one dragged you in off the streets, did they?'.'

Mrs C: 'A doctor shouted at me because he couldn't get a needle into a vein in my arm.'

Mrs D: 'I went in to see the consultant and he told me I had breast cancer and would need an operation when they could fit me in. That was it. The consultation didn't last more than 3 minutes. My world had been turned upside down. I went outside, got into my car, drove home in a state of shock and then burst into tears when my children came into the house.'

Mr E: 'When I asked the surgeon who had told me that I needed an operation whether the operation was essential he said: 'If you don't want the operation I've got plenty to be getting on with. It makes no difference to me."

Mrs F: 'When I had a breast X ray the person who did it was very cruel and rude. My breasts hurt for 5 days afterwards.'

Mrs G: 'I had to have an intimate examination. A group of doctors gathered around and were laughing and giggling and telling rude jokes. I will never again have an intimate examination. I would rather die.'

Mrs H: 'The consultant asked me if I was feeling better. I said 'No' because I was still in pain. He then shouted at me and I burst into tears. He shouted 'Look at me when I talk to you!' but I couldn't because I was crying so much.'

Mr I: 'My wife has been in hospital three times so far this year but no one has told us anything.'

Mrs J: 'I was so nervous my hands were shaking and I couldn't undo my bra. The doctor shouted at me to hurry up because time was money.'

Mrs K: 'My GP fixed me up with a private appointment with a consultant. It cost me a lot of money. The consultant just said that I needed to see a different sort of specialist and that I should have known. When I didn't pay the bill the consultant's manager phoned up and said I had broken a contract. He has now issued a court summons.'

Mrs L: 'When my husband was in hospital the doctor in charge treated him very badly. Two weeks ago I heard that the doctor had been admitted to the same ward that my husband had been in. I pray to God to forgive me for my thoughts.'

Mrs M: 'I sat on the couch in one of those funny little gowns they give you to wear. Suddenly the screens were pushed aside and a doctor burst in. He ripped open my gown so that I was naked, prodded me about and then left as suddenly as he had arrived. He didn't say a word to me. Ten minutes later a nurse came in to say that I could go.'

Mrs N: 'When I saw the consultant privately he was very nice. But when I had to go and see him in a public clinic he treated me like dirt.'

Mrs O: 'I waited nine months for an appointment at the hospital. But I didn't see a doctor at all. I saw a young student who was very arrogant. I'd have been ashamed of him if he'd been my grandson.'

Mrs P: 'I went into a local hospital for a sterilisation. I was told to arrive before 7.00 am. I was there at 6.30 am. I was totally ignored as were 7 or 8 other women, all waiting for various operations. At 9.30 am I was told there were no beds but that they would go through with the op and hope that some people were discharged. I was sent to another floor, frightened, alone and stressed to be greeted by some doctor I had never seen before. I was practically thrown onto a trolley and wheeled to theatre with my pre-med tablet being shoved in my hand to swallow on the way. My husband phoned to find out how I was doing and was told he wasn't a real relative (not a blood relative) so no information could be given to him. Afterwards I was left on the trolley with the feeling I was alone and was going to die. I still had the effects of the anaesthetic in my body. The thing used to put the anaesthetic in me was hanging out of my hand. I told them I was allergic to plasters but they still put plasters on my stomach causing a bad, itchy rash. I was left to wander around for a toilet, walking into walls and other trolleys on my own, still only just conscious. I lay on my trolley in a side room no bigger than a cupboard until 4.00 pm with extremely painful backache and no painkillers. A nurse then arrived, gave me a couple of tablets and said they were closing the ward as it was for day patients only. I had to dress myself, phone my father to pick me up (the right phrase as I could hardly walk) and bring me home. I was told there was no need to return for a check up or any follow up to make sure I was OK. When I went home my pulse rate was 130 a minute. The only thing they gave me was a letter to give my doctor saying I had been sterilised and a couple of typed lines on a scrap of paper telling me not to drive or drink for 24 hours. How can our health system treat people like this?'

Doctors are supposed to help make people better. But time and time again their thoughtlessness is making people worse.

Doctors often try to excuse their rudeness by complaining that they are overworked. But that is simply not true. In the last 10 years the average doctor's workload has fallen dramatically. According to one report the average family doctor now works a 23 hour week. One doctor boasted that he manages to cram his workload into just 7 hours a week.

Hospital consultants are even worse. Many deliberately keep their hospital waiting lists as long as possible so that they'll get more paying patients at their private clinics. Many never even turn up for hospital clinics but instruct junior, untrained doctors to do the work for them. Meanwhile they're busy seeing private patients. Most seem to forget that patients are nervous. They explain nothing and discourage questions. Most regard their time as so important that they instruct administrators to bring patients in hours early. Most forget the fact that patients may be embarrassed at being seen undressed.

Many hospital consultants are beginning to complain about the number of patients who don't turn up for out patient appointments. Personally, I'm not at all surprised that the number of patients failing to turn up has become an epidemic.I'm more surprised that any patients bother to turn up.

Here are the complaints patients most commonly make to me about hospital consultants and hospital out patient departments.

1. 'You only get two minutes'
My investigation shows that this is a slight exaggeration. The average out patient in some clinics can probably expect to spend 3 or even 4 minutes with the doctor. What an insult! What a waste of time.

2. 'The doctor doesn't know anything'
Most outpatient clinics are run not by consultants but by junior hospital doctors who often have only a few months or even weeks experience. They have probably never seen the patient before. And they'll never see him again.

3. 'No one tells you anything'
I'm convinced that some hospital doctors are trained by the security services. They never tell patients anything.

4. 'You're treated like dirt'
Too often true. Patients are herded into groups and treated like mentally incompetent aardvarks. Too often nurses give the impression that they got their training at Belsen.

5. 'They keep you waiting for hours'
Oh, boy do they keep patients waiting! You may get less than 5 minutes with the doctor but it'll take up half a day of your time. Why do hospitals always assume that no one else has anything important to do?

6. 'They don't give you much notice'
A surprising number of patients get less than a week's notice - often after waiting for weeks or months. There is absolutely no excuse for this - apart from incompetence.

7. 'There's no privacy'
Most hospitals seem to assume that patients are exhibitionists. Not true. Most patients dislike having their private parts viewed by orderlies, porters and electricians.

8. 'The doctor doesn't speak my language'
Most patients don't care two hoots where doctors come from as long as they are competent. But all patients like to be treated by doctors who can speak their language.

9. 'They never bother to tell you that an appointment is cancelled'
'I waited five months for an appointment,' complained one patient. 'When I got there I was told that the doctor had gone on holiday a week before and there was no one there who could see me.' Inexcusable. No doctor goes on holiday without giving at least a month's notice. A letter or phone call would save everybody time.

10. 'They only wanted me there for some research project'
Every week thousands of patients waste their time (and money) visiting hospitals where doctors are conducting private research programmes. Many feel 'used'. I don't blame them.

Hospital doctors sometimes do important work. I'm not arguing with that. But there is too much thoughtlessness, too much arrogance and too little thought for the feelings and needs of patients (who are, after all, the people paying everyone's salary).

Frequently, doctors just don't seem to think before they open their mouths.

Just before a trip to Paris I had to have some hospital tests done. After one set of tests a specialist told me that there was a chance that I had cancer. 'But don't worry about it,' he said cheerfully. 'Go and enjoy your stay in Paris. We'll do some more tests when you get back.'

I had to explain that I would find it difficult to relax with such a threat hanging over my head. Within a few hours the extra, additional test had been done and I had been given the 'all clear'. If I hadn't insisted on having my problem sorted out there and then the extra, unnecessary worry could, I suspect, have made me genuinely ill.

Patients would get treated better if doctors always pretended to themselves that every patient they saw was a close relative or loved one.

I've always believed that a doctor should treat every patient as he would want his own family to be treated.

Today's consultants must all hate their families.

Too many doctors seem to believe that they are superior beings; that their authority should never be questioned; that their time is more important than anyone else's and that they are the only people entitled to respect.

I suspect that part of the problem lies in the way that medical students are trained. Although medical students are taught a great deal about disease they are frequently not told very much about patients. They are, I suspect, taught too little about human rights and not enough about a doctor's responsibilities. They are, I fear, also taught too little about the impact a patient's feelings can have on his health.

And part of the problem is the fact that it is too easy for doctors to forget that patients are paying their fat salaries. Because no money changes hands in the clinic or consulting room it's too easy for a doctor to forget that the patient is a consumer and is entitled to respect as a right not a favour. (It would be nice if doctors offered patients respect because they cared about them but that might be too much to hope for).

Certainly when money does change hands doctors seem to be much nicer. And hospital consultants are more likely to have private patients and two sets of standards.

One reader had first hand experience of this.

To save time she was advised to see a consultant privately, away from the hospital. He was, she says all smiles and charm. He stood up when she entered his consulting room. He was polite, kindly and thoughtful. But the treatment went on for weeks and the bills got bigger and bigger. Eventually my reader couldn't afford any more private treatment. So she made an appointment to see the same consultant in his hospital clinic.

'He was,' she told me, 'rude, insolent and arrogant. He didn't even look up when I went into the consulting room. He examined me but spoke only through the nurse who was with him. He was brusque. No smiles and no handshakes. He seemed a different person.'

What a terrible indictment that is. It isn't just administrators who sometimes give the impression that they would prefer it if their hospitals were empty of patients. A lot of consultants give that impression too.

'Patients are a bloody nuisance,' I'm told an egocentric hospital consultant roared recently when confronted by a patient who had the audacity to ask a question. 'They clutter up the corridors and bleed all over the wards. We could get twice as much done if they'd all bugger off back home.' His troop of tame, sycophantic, middle-ranking nurses and junior doctors, crowding around him like lakeside ducks waiting for scraps of bread, laughed dutifully.

My informant, the unfortunate patient who had the temerity to question the white coated god, tells me she tried to disappear down the bed and spent the rest of the day shivering with shame, fear and embarrassment.

The tragic truth is that thousands of men and women in white coats are so bad mannered that they would be better suited to work as policemen or debt collectors.

Bad behavior of this sort isn't just unforgivable bad manners it's also bad medicine. For years now there has been plenty of evidence to show that patients get better quicker when they are treated kindly. Patients who are given information about their illnesses, and who are treated with courtesy and respect, need fewer drugs and go home quicker than patients who are treated like dirty laundry.

All things considered it is becoming increasingly clear that patients might be better off if hospital doctors - particularly surgeons - were replaced by computers and robots. Indeed, there is now a growing amount of evidence to show that computers practise hospital medicine better than human beings.

* One trial has shown that computers are 10% better than consultants at making diagnoses.

* A second trial - involving nearly 20,000 patients - confirmed that computers are far better than most doctors at diagnosing patients suffering from severe abdominal pains.

* In America robots have been devised that can assist with hip replacement surgery.

* Computer controlled robots are being used to perform brain surgery in France.

* Scientists are developing robots that can perform prostate surgery.

* In Germany there are plans to use robots in ear, nose and throat work.

Computers and robots have a number of advantages. They do not get tired. They are speedy and predictable. They are not subject to prejudice. They are far less vulnerable to the blandishments and bribes of the drugs industry. And, of course, they aren't rude, domineering or arrogant. Indeed, they can be programmed to treat patients politely.

I wonder how many patients would prefer a polite, efficient computer to a rude, incompetent human doctor?

There are two vitally important lessons here.

First, do not let yourself be pushed, bullied, frightened or angered into abandoning orthodox medicine completely. Alternative medicine has its uses and its place but for some illnesses orthodox doctors can provide a more useful, more effective service if they are used properly.

Second, you must learn to stand up for yourself when dealing with doctors. If you don't, then the chances are high that you will be treated without respect. Don't be concerned that by sticking up for yourself you will annoy your doctor and possibly endanger the treatment you receive. All the available evidence shows very clearly that patients who are aggressive and demanding (and, as a result, often unpopular with doctors and nurses), and who ask questions and insist on being told what is happening to them - and why - not only stand a much better chance of getting better but also get better far quicker too.

2. Tests And Investigations - Are They Safe?
At least two thirds of all the tests and investigations ordered by hospital doctors and family doctors are unnecessary.

* One survey has shown that routine blood and urine tests help doctors make a diagnosis in only 1% of cases.

* Another survey recently showed that when hospital doctors order tests to identify bugs most of the patients involved are sent home before the results of the tests are known!

* Something like nine out of ten X rays are unnecessary.

Unnecessary tests and investigations are ordered for several reasons. Sometimes doctors do them because they feel that they will be less likely to be sued if they can show that they did lots of tests. And younger doctors may order routine tests so that they'll have all the possible answers available if quizzed by senior consultants.

None of this would matter much if tests were cheap and easy to do and if they were always harmless and reliable. But many of the unnecessary tests doctors order are complex, and expensive. For example, the World Health Organisation reports that X rays can account for between 6% and 10% of a country's expenditure on health!

Even worse many of the investigations which are done result in patients getting the wrong treatment or getting too much treatment and, tragically, tests aren't as reliable as doctors and patients often think they are.

Most laboratory tests are only 95% accurate - even when all the equipment in the laboratory is working absolutely perfectly (something that usually happens about once a week). So if a patient has twenty laboratory tests done then the chances are that even if he is perfectly healthy the tests will show at least one abnormality.

One recent study showed that out of 93 children who had been diagnosed as having heart disease - and who had lived as 'heart patients' - only 17 really had heart disease! The rest had suffered severe restrictions on their activities for no good reason at all!

To all this must be added the fact that many tests are dangerous - and can even kill. X rays, for example, are so overused and misused that they constitute a considerable health risk.

Don't put too much faith in tests. And don't let your doctor perform too many. Tests aren't as necessary, as useful or as reliable as most people think they are.

3 How Will Your Drug Affect You?
Every time your doctor writes out a prescription he is conducting an experiment. He doesn't know exactly what will happen when you take the drug he is prescribing.

One reason for this is the fact that neither pharmaceutical companies nor doctors ever bother to test drugs properly before making them widely available. In an editorial in a leading international journal one commentator recently admitted that 'only about 15% of medical interventions are supported by solid scientific evidence'. (Yes, you read that correctly: 'only about 15% of medical interventions are supported by solid scientific evidence.')

Another problem is that we are all different. When you take a pill it may give you diarrhoea. When your best friend takes the same drug it may make her constipated. When your uncle takes the same drug it may give him a skin rash. The pill may do its intended job for three, two, one or none of you.

4. Is Your Doctor Trying Out A New Drug On You?
Every week thousands of patients are used - often unwittingly - in medical experiments. Doctors in general practice and in hospitals make huge personal bonuses by testing new drugs for pharmaceutical companies. But patients are often put at risk unnecessarily.

Be suspicious if your doctor makes a great fuss of you, is unusually polite or wants you to return to the clinic at very regular intervals. If, instead of handing you a prescription, your doctor gives you a bottle of pills and doesn't charge you for them then the pills may be new and you may be taking part in a drug trial. Watch out if your doctor asks you a lot of questions that don't seem entirely relevant. If your doctor is doing a clinical trial for a drug company he will almost certainly ask you lots of questions about side effects - questions that he would not normally ask. Be wary if your doctor wants you to undergo blood or other tests but doesn't explain why the tests are necessary. Drug companies paying for new drugs to be tested may want blood tests performed.

If your doctor admits that he wants to try out a new drug on you make sure that there is no existing alternative. New drugs should only be tried out on patients when there are no effective and safe alternatives.

Why should you risk your health (and your life) to benefit your doctor's bank balance and the drug company's profits?

5. What Are The Risks Of Taking Part In An Experiment?
Women around the world are being invited to take part in the clinical trial of a drug called tamoxifen.

Researchers have been given approval to give tamoxifen to thousands of perfectly healthy women to see if the drug stops them getting breast cancer.

My personal advice to any woman invited to take part in this trial has been to say 'no' and I have led an international campaign questioning the wisdom of the trial.

The drug tamoxifen isn't new. For several years it has been given to women who are suffering from breast cancer and as a treatment for infertility. The risks associated with this drug may be low enough to justify its use when a woman's life is threatened because she already has cancer. But I certainly wouldn't sleep at night if I had given this drug to a healthy woman.

The possible side effects which may be associated with tamoxifen include: hot flushes, vaginal bleeding, gastro-intestinal pain, light headedness, skin rash, cataracts, fluid retention, and endometrial carcinoma.

I suppose those who are involved in this trial may claim that women won't mind feeling light headed, developing a skin rash and cataracts and suffering from hot flushes and vaginal bleeding if there is a chance that they will be less likely to get breast cancer.

But what about that last hazard: endometrial carcinoma? Endometrial carcinoma is cancer of the uterus and so, according to the existing information we already have about this drug, we know that there is a possible risk that it may cause cancer of the uterus.

What sort of inspired lunacy is this?

These healthy women - some of them still in their 30s - will be given the drug to take for several years.

I believe that just as many deaths from breast cancer could be prevented by teaching women how to examine their own breasts and spot potentially cancerous lumps at an early stage. Furthermore, I also believe that the evidence clearly shows that a huge number of deaths from breast cancer could be avoided by persuading women to stop eating meat and significantly cut their consumption of fatty food.

It is, incidentally, also interesting to note that experiments have shown that tamoxifen can cause cancer of the liver when given to rats and gonadal tumours when given to mice. This evidence was, I assume, ignored by the organisers of the trial - presumably because they recognised that animals are so different to people that animal experiments cannot be replied upon.

I believe that patients should always be wary about taking part in medical experiments, although if you are ill and there is no known remedy for your condition then agreeing to take a new and untested product may be worthwhile.

6. Are You Taking Too Many Antibiotics?
When antibiotics - drugs such as penicillin - were first introduced in the 1930s they gave doctors a chance to kill the bacteria causing infections and to save the lives of patients who would otherwise have died of infections such as pneumonia. Antibiotics were regarded as genuine life-savers; heralding a revolution in health care.

Although it is certainly true that the impact made by antibiotics has been exaggerated (many of the diseases which are caused by organisms which are susceptible to antibiotics were on the decline before the antibiotics were introduced) these drugs are undoubtedly of considerable value.

The problem is that although doctors are aware of the advantages of these drugs (if they are in any doubt the drug companies will frequently remind them) they seem unaware of the hazards associated with their unnecessary use.

If you have a serious or troublesome infection - bronchitis, sore throat or cystitis for example - the chances are high that your doctor will prescribe an antibiotic.

If you are innocent and naive you might imagine that the prescribing of an antibiotic will have been done scientifically and that your doctor, as a man or woman of science, will have carefully chosen a drug specifically designed to eradicate the type of bug causing your infection and prescribed for precisely the right number of days.

You would, however, be quite wrong to assume that doctors know what they are doing when they prescribe antibiotics. Antibiotics are powerful drugs. They do save lives. But, in general, they are prescribed with neither sound logic nor scientific understanding. The prescribing of antibiotics is a virtually random exercise. The average tapioca brained traffic warden could prescribe them with as much sense and understanding as the average doctor. Visit one doctor with cystitis and she will give you enough antibiotics to last you for five days. Visit the doctor next door, complaining of exactly the same symptoms, and he may prescribe the same antibiotic but give you enough pills to last for seven days. And visit a third doctor and she may give you pills to last for ten or even fourteen days. Where, in the name of Areolus Phillipus Theophrastus Bombastus von Hohenheim, is the sense in any of this?

This bizarre situation occurs not because doctors haven't bothered to learn how to prescribe antibiotics but because no one knows how antibiotics should be prescribed. Astonishingly, no tests have ever been done to find out precisely for how long antibiotics should be given! Research scientists have been far too busy enjoying themselves doing unspeakable things to monkeys, cats and puppies to bother doing such useful or practical research.

All that is bad enough. But it isn't the end of the horror story. For although scientists know which antibiotics should be used to combat which bugs the evidence shows that the selection of a drug to prescribe is generally done with the sort of scientific judgement the average six year old might apply when picking a coloured sweet out of a box.

As any regular surgery goer will know that there are scores of antibiotics available. Some of these pills are simply variations on profitable themes. But there are some important differences between many of these pills. Drugs are designed to combat specific types of infection. However, most doctors don't usually bother to try to match antibiotics with bugs; instead they simply write out a prescription for any old drug. They tend to choose a drug because they like the name - or can spell it - rather than because it is appropriate.

The end result is that although you might think that the antibiotic you are prescribed has been chosen specifically for your infection you would probably be wrong. Your doctor will have probably simply picked a name at random. She is more likely to prescribe a drug because its name appears on the free disposable pen she happens to be holding than because she knows that it is the best and most suitable drug to kill the bug with which you are infected. Worse still, most doctors are so darned stupid that they happily prescribe antibiotics for virus infections even though viruses are not susceptible to antibiotic therapy.

Today, one in six of the prescriptions doctors write is for an antibiotic and there are at least 100 preparations available for doctors to choose from. Sadly, there is no doubt that most of the prescriptions which are written for antibiotics are unnecessary. Many patients are suffering from viral infections which are not susceptible to antibiotics, and others would get better by themselves without any drug being prescribed. Various independent experts who have studied the use of antibiotics claim that between 50 - 90% of the prescriptions written for antibiotics are unnecessary.

To a certain extent doctors over-prescribe because they like to do something when faced with a patient - and prescribing a drug is virtually the only thing most of them can do. To some extent prescribing a drug is a defence against any possible future charge of negligence (on the basis that if the patient dies it is better to have done something than to have done nothing).

But the main reason for the over-prescribing of antibiotics is, without doubt, the fact that too many doctors are under the influence of the drug companies.

The over-prescribing of antibiotics would not matter too much if these drugs were harmless, and if there were no other hazards associated with their use. But antibiotics are certainly not harmless. I believe that antibiotics kill thousands of patients a year and if nine out of ten prescriptions for antibiotics are unnecessary then it is not unreasonable to assume that nine out of ten of those deaths are unnecessary too.

And antibiotics don't only kill patients. The unnecessary and excessive use of antibiotics causes allergy reactions, side effects and a huge variety of serious complications.

There is also the very real hazard that by overusing antibiotics doctors are enabling bacteria to develop immunity to these potentially life saving drugs. There is now no doubt that many of our most useful drugs have been devalued by overuse and are no longer effective.

If your doctor prescribes an antibiotic for you don't be afraid to ask him whether you really need it. He may simply be prescribing the antibiotic because he thinks you will be disappointed if you don't get one.

The over-prescribing of antibiotics is not a new phenomenon.

Over twenty years ago, in my first book, 'The Medicine Men', I pointed out that one huge survey had shown that only one third of the patients given antibiotics had infections at all! Other surveys, I explained, had shown that even when patients do have an infection the antibiotic prescribed is usually the wrong one.

Nothing has improved since then. Today's doctors are just as criminally inept as their predecessors were. And members of the medical profession still treat me like a pariah for daring to expose these professional shortcomings.

But it is now clear that the warning about antibiotics which I gave two decades ago was absolutely accurate. The careless, inaccurate and inappropriate prescribing of antibiotics by thousands of ignorant and careless doctors is one of the main reasons why a growing number of bugs are resistant to antibiotic therapy. Many once powerful drugs no longer work because doctors have handed them out like sweeties and bugs have been given the chance to grow stronger and resistant to treatment. An ever increasing number of patients are dying because antibiotics no longer work as well as they used to work.

During the last twenty five years I have made scores of predictions about health matters. Most of those predictions were laughed at by the medical establishment when I first made them. Nearly all of them have already come true.

I now add another prediction: infectious diseases will soon become one of the most feared and important causes of death - just as they were before the development of antibiotics. This tragic state of affairs will be the fault of those doctors who have overprescribed these drugs.

7. How Safe Are Repeat Prescriptions?
A growing number of prescriptions (now said to be about half of all those written) are provided without there being any meeting between the doctor and the patient. The patient writes or telephones for a new supply of a specific drug and then, a day or so later, either collects or receives through the post the appropriate prescription.

This system of providing prescriptions 'on request' was originally designed to help patients suffering from chronic disorders such as diabetes, high blood pressure or epilepsy. Patients suffering from disorders which tend to vary very little over the months do not need daily, weekly or even monthly medical examinations but they may need regular supplies of drugs. For them to have to visit a doctor simply to obtain a prescription is clearly a waste of everyone's time. Doctors do not usually prescribe quantities of drugs likely to last more than four to six weeks since some drugs deteriorate if kept too long and most practitioners feel that it is unwise to allow any patient to keep excessively large quantities of drugs at home.

Unfortunately, repeat prescribing is not always restricted to patients with long-term problems requiring continuous medication. Patients who really should see a doctor (rather than simply continue taking tablets) sometimes ask for repeat prescriptions and, to the shame of the medical profession, not infrequently obtain them.

Many patients have become psychologically dependent upon sleeping tablets and tranquillisers because of the ease with which they have been able to obtain repeat prescriptions.

Arrangements for obtaining repeat prescriptions vary a good deal from one doctor's practice to another's. In some practices patients entitled to receive prescriptions are issued with cards on which the drugs which they are allowed to receive without any consultation are listed. There may be a limit on the number of prescriptions which the patient may obtain without being reviewed. In other practices the cards detailing drugs which can be provided on repeat prescriptions are kept with the patient's notes so that the receptionists, who usually write out repeat prescriptions, can check on drugs, and dosages, and make a note of the number of prescriptions used.

Theoretically, doctors signing prescriptions should check all the details, including specific points such as the dosages and quantities of drugs to be supplied, and general points such as the suitability of continuing with the treatment. In practice many prescriptions supplied in this way are signed with few or no checks being made. I have, in the past, obtained evidence that some doctors sign piles of virgin prescription forms and leave their receptionists to fill in the blanks. I have little doubt that this practice continues.

I suggest that patients receiving drugs on repeat prescriptions should always check that the tablets they receive match the tablets previously prescribed, and that any instructions on the bottle label match previous instructions. If there is any confusion or uncertainty then a telephone call should be made to the surgery.

As a general rule, I suggest that only patients who have established and long-term clinical problems should obtain drugs on repeat prescriptions and they should visit the surgery at least once every six months to check that the medication does not need changing. Patients with short-term or acute conditions who need medication should always speak to a doctor.

Repeat prescriptions can be a convenience. But they can lead to drug misuse and eventual abuse - and to addiction and dependence.

8. Questions To Ask Before Taking A Prescribed Drug
You will improve your chances of benefiting from a drug - and also minimise the risk of problems - if you know what to expect. You have a right to know what you are taking - and why. Don't be shy. Here are some questions you should ask your doctor:

1. What is this medicine for?
2. How long should I take it? Should I take it until the bottle is empty or until my symptoms have gone?
3. What should I do if I miss a dose?
4. What side effects should I particularly watch out for? Will the medicine make me drowsy?
5. Am I likely to need to take more when these have gone? Should I arrange another consultation?
6. Are there any foods I should avoid? Should I avoid alcohol?
7. How long will the medicine take to work - and how will I know that it is working?

9. Don't Let Your Doctor Label You
If, a few years ago, you went to see your doctor complaining that you felt miserable and down in the dumps he would have probably prescribed a harmless tonic, chatted to you for twenty minutes and told you to try and get out and enjoy yourself a bit more.

Today, if you go to see your doctor and complain that you feel under the weather he will probably diagnose you as depressed. There is an excellent chance that he will then start you on one of the many new powerful chemicals now available.

Up until recently depression was a fairly uncommon disease.

The value of world wide sales of anti depressants rarely rose above $2,500,000,000 a year.(To the world's drug companies that's small change - hardly worth bothering to take to the bank).

But today depression seems to be one of the fastest growing diseases in the world. Millions of people now suffer from it. And the boom in the diagnosis of depression has coincided with the development of special, new, expensive, chemical anti depressants.

My fear is that the diagnosis of 'depression' is now often being made when patients are simply rather miserable or unhappy or generally fed up with their lives.

You will not be surprised to hear that although I (well known to be suspicious and rather cynical of the motives of the pharmaceutical industry) worry that some of these new anti depressant drugs may, in due course, prove to produce dangerous or nasty side effects, the majority of doctors are happily prescribing them by the bucket load.

My big fear is that the drugs which are now being prescribed with the enthusiasm which was shown for the benzodiazepine tranquillisers in the 1970s (and, by many doctors, for patients with very similar symptoms) may turn out to produce massive problems of their own.

It may well be true that a relatively small number of depressed patients can be helped by taking drugs.

I have no doubt that people with real depression, who suffer such symptoms as constant crying, an inability to sleep, a total feeling of worthlessness, a loss of appetite, suicidal tendencies or other serious symptoms of depression, need sophisticated, professional help.

But I believe that the amount of good that is being done by these powerful drugs could be far outweighed by the possible harm.

I have absolutely no doubt that there is more sadness, despair, and unhappiness in our society than there has ever been in any previous society but I strongly suspect that many of the patients diagnosed as suffering from 'depression' may well be 'sad' (and suffering from the disorder which I call The Twentieth Century Blues) rather than clinically 'depressed', and may need help of a different kind.

I believe that instead of automatically dosing all their unhappy patients with powerful and potentially hazardous chemicals, and attempting to tackle a vague and ill defined disease, doctors should be encouraging more of the sad, the despairing and the unhappy to try to tackle the specific causes of their unhappiness themselves. It can be done.

Depression is not the only disease which is said to be commoner today than it used to be.

Asthma is another disorder which is often said to affect more people now than in the past.

And arthritis is a third disease which is alleged to be getting commoner.

In my view the problem is not that these (and many other) diseases are just becoming commoner, but that doctors are diagnosing them more often!

There is a huge difference.

Take a mild wheeze into a doctor's surgery these days and the chances are that the doctor will tell you that you've got asthma and that you must use an inhaler for the rest of your life.

Complain of an aching joint and you'll be labelled 'arthritic' - and given pills to take.

As a result of this wild, over-prescribing policy countless thousands of people who regard themselves as asthmatics, or arthritics are nothing of the sort. They have, in truth, merely exhibited minor, temporary symptoms which do not need long term treatment.

The driving force behind this vast over prescribing is, in my opinion, the ubiquitous drugs industry.

The drug companies want doctors to prescribe more medicines (for the simple reason that prescribing more pills pushes up profits even higher) and it is, I believe, their subtle, ever present, overall, global influence which results in doctors deciding that every wheeze must be treated as asthma, that every ache must be diagnosed and treated as 'arthritis' and that every mild bout of unhappiness must be treated as depression.

Diseases such as asthma, arthritis and depression are perfect for making big profits because patients labelled as suffering from these conditions are often advised to take pills for years or even decades.

It is by no means unusual for patients to be told that they need drug therapy for life!

With pills often costing a small fortune the profits on each new patient can be colossal.

This bizarre, ruthless but profitable philosophy works because doctors are usually far too ready to listen to the drug company salesmen. These days most doctors are actually taught about new drugs not by independent experts but by paid salesmen!

My advice is simple: if your doctor tells you that you are suffering from a long term disorder for which you need to take long term drug therapy - you should ask for a second opinion!

Never forget that four out of ten patients who take pills suffer side effects. If you are taking pills because you genuinely need them then the risks may be acceptable. But if you are taking pills unnecessarily then the risks are unnecessary too.

10. How To Survive In Hospital
Going into hospital is a frightening and worrying experience. The very smell and sound of a hospital is enough to make most people's hearts beat faster.

When we go into hospital we are inevitably nervous about what is going to happen and anxious about the outcome. But on top of those natural fears we worry in case we do something silly or offend someone.

To the outsider hospitals seem full of important looking people in uniforms - all rushing round and all knowing exactly what they are doing.

1. Before you go into hospital try and find out as much as you can about the rules and regulations for patients and visitors. Good hospitals produce small booklets for new patients. Get one if you can. If the hospital you're going to doesn't produce a booklet or leaflet of its own then find out as much as you can over the telephone. You need to know when visiting times are; whether there are any special rules about children visiting; what buses stop near to the hospital and what car parking facilities there are for visiting. You also need to know what the different types of nurses' uniform mean!

2. So that you'll know what to expect find out what sort of ward you'll be going into. Open plan wards may seem a little daunting but don't be put off. The evidence shows that nurses can keep a closer eye on patients in large wards than they can when patients are cooped up in private rooms. If your condition is likely to require very special care then you may be put into an Intensive Care Unit or Coronary Care Unit. Children under 12 are usually put onto special children's wards. But older children often go onto adult wards - where they're usually much happier and invariably spoilt rotten by the nurses.

3. Carefully plan what to take with you. Here is my basic check list: