Medicines can be among our greatest curses

Dr Vernon Coleman





The following essay is taken from `The Medicine Mení by Vernon Coleman, which was first published in 1975.

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The diseases from which we suffer and die today are very different from the diseases which were responsible for illness and death a few score years ago. In the United Kingdom, for example, the mortality from gastro-intestinal infections has dropped 80 per cent since 1930; the number of deaths from pulmonary infections is 70 per cent down on the number in 1930. In 1940 there were 4,000 cases of diphtheria a year in England and Wales. Today cases of diphtheria are rare. In 1925 there were 40,392 deaths from tuberculosis in the United Kingdom, but for the last year for which there are recorded details available there were only 1,606. Between 1931 and 1935 the average number of deaths per year of children aged between 1 and 14 in the United Kingdom was 3,017. In 1970 there were about 400 deaths of children in this age group.

There are, of course, a number of reasons for this vast improvement in our health. It is probably true to say that increased prosperity is the biggest single reason why more of us live to a ripe old age. Few people starve to death in modern Britain; most live in fairly comfortable houses with running water, sewage disposal facilities and plenty of winter fuel.

And, of course, in the 1920s there were very few drugs available. There were such things as aspirin, quinine, digitalis, barbiturates, salvarsan, morphine, chloroform and nitrous oxide but there was very little else, and even these compounds were rarely totally reliable, safe or effective.

As recently as 1935, three-quarters of the prescriptions signed today could not have been written. Nineteen out of twenty of today's leading prescription medicines have been developed since 1932, when the first sulphonamide was produced. It has been only during this century that doctors have been able actually to do any good. Professor Henderson of Harvard has estimated that 1912 was the first year in human history when the random patient with the random disease consulting the random doctor had a more than fifty-fifty chance of benefiting by the encounter. The power of the physician has increased as more and more new and effective drugs have been discovered.

The pharmaceutical industry which supplies us with our medicines has grown with the discoveries. As recently as the nineteenth century, doctors were making their own pills and handing them out to patients themselves. The first tablet-making machine was developed in the middle of the nineteenth century, and by the 1890s aspirin tablets were being made by specialist companies. The discovery of the sulphonamides in the 1930s and the production of penicillin in the 1940s gave the drug industry a tremendous boost and attracted many more companies into the business. For the first time in history it was possible to produce drugs which actually worked reliably. Companies producing these effective drugs made fortunes within a comparatively short period of time, and many other entrepreneurs were attracted by the prospect of making a fortune by finding a new drug.

Doctors benefited from the discoveries too. They were at last able to prescribe compounds which could be seen to work with great success. In the nineteenth century, members of the medical profession had relied largely on bottles of coloured water which did neither much good nor much harm. Doctors made a living because some patients got better anyway. In the twentieth century, doctors were actually able to influence the rate at which patients recovered. Thanks to the drug industry's discovery and marketing of new, effective compounds, members of the medical profession had real power at last.

Thanks to the new drugs which have been developed, fewer people have to watch helplessly while their relatives die of infectious diseases, tuberculosis, diabetes and so on; and far fewer children are crippled with poliomyelitis or rickets. There is not so much scurvy, and malaria is under better control. But new discoveries and new developments have also brought problems. Although for the first time in history really powerful and effective drugs have been made available, none of those involved - manufacturers, doctors or patients - seem really aware of the power of the products. Some of the problems created by the drug explosion have still not been solved. Other problems seem to arise as more and more drugs are put on the market.

Doctors have benefited a great deal from the pharmaceutical revolution. They now have status, authority and power. But to many people, doctors do not seem to have accepted their new status, authority and power with the correct amount of responsibility. Medical education is not very different today from what it was half a century ago when most of the modern drugs had not been developed. Many doctors in practice today qualified thirty, forty or more years ago when most of the drugs we now take for granted were unheard of. There are many practitioners who qualified before insulin, penicillin and other important products were discovered. There is no legal obligation for any doctor to keep up with therapeutic advances.

There are thousands of drugs available for prescription but doctors have not yet considered it worthwhile to arrange for an independent assessment of each drug so that they can obtain an unbiased view of an advertised product. Most of the information reaching doctors about new drugs comes from the drug companies. The information is basically promotional material: it is necessarily biased.

The drug companies, anxious to have a share in the huge international market for drugs, put a great deal of pressure on doctors to prescribe their products. They spend more on promotion to doctors than they spend on research. As well as selling drugs for prescription only, many companies also produce drugs to be sold in pharmacists' shops. These medicines are advertised just as enthusiastically and dishonestly as medicines were advertised a century ago. But today some of the medicines sold in chemists' shops contain powerful ingredients and can therefore be dangerous.

Patients themselves seem to have an insatiable demand for medicines. They put a great deal of pressure on doctors to prescribe drugs and the result is that far too many drugs are prescribed. Because members of the public do not realise how powerful these drugs are, they often forget to take them as instructed and instead take them when and how they feel like doing so. The results are not infrequently fatal, for modern drugs, being powerful, can also kill.

It is not only when taken incorrectly, however, that drugs can kill. Drugs can also kill and cause damage when taken exactly as the doctor ordered. During recent years, many thousands of patients have died as a result of taking medicine prescribed for a fairly mild condition. The thalidomide tragedy made it clear to us all that medicines can be dangerous, but it did not seem to have any effect on the great yearning for tablets. Among the many new diseases discovered in the last few decades, there are many drug-induced diseases we would have never known had it not been for the powerful drugs we have made. It has been reported many times that over 10 per cent of the people who take medicines suffer severe side-effects. Even that wonder drug, penicillin, kills thousands of people every year.

We are all to blame. The drug industry is too ready to gloss over unfortunate results and conveniently to forget about dangerous side-effects. Doctors are too ready to prescribe and too lax in deciding whether the risk of the illness really justifies the risk of the medicine. And patients are too determined to take medicine regardless of whether they really need it, and too shy about making sure that they are only given medicines which have been well-proven and which are safe and reliable. Doctors are too ready to prescribe new and untried drugs, and patients are too ready to take them. Thousands die every year because of errors made by manufacturers, doctors and patients themselves.

Medicines would be among our most useful tools if only we would use them carefully. Used carelessly and unnecessarily they can be one of our greatest curses.

NOTE
This essay is taken from `The Medicine Mení by Vernon Coleman which was first published in 1975. `The Medicine Mení is available via the bookshop on www.vernoncoleman.com

Copyright Vernon Coleman 1975 and 2024





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