How Doctors Have Betrayed Patients

Dr Vernon Coleman

The following essay is taken from `Betrayal of Trust’ by Vernon Coleman – first published in 1994, exactly 30 years ago.

`Those who argue that doctors are responsible for any improvement in life expectancy which we may enjoy overlook the fact that from the dark ages, through the Renaissance and up to the first few decades of the 20th century, infant mortality rates were absolutely terrible and it was these massive death rates among the young which brought down the average life expectation.

The Foundling Hospital in Dublin admitted 10,272 infants in the years from 1775 to 1796 and of these only 45 survived. In Britain deaths among babies under one year old have fallen by more than 85% in the last century. Even among older children the improvement has been dramatic. In 1890 one in four children in Britain died before their tenth birthday. Today 84 out of every eighty five children survive to celebrate their tenth birthday. These improvements have virtually nothing to do with doctors or drug companies but are almost entirely a result of better living conditions. In 1904 one third of all British schoolchildren were undernourished. Poor diets meant that babies and small children were weak and succumbed easily to diseases. Older children from poor families were expected to survive on a diet of bread and dripping and many women who had to spend long hours working in terrible conditions were unable to breast feed their babies, many of which then died from drinking infected milk or water.

When the improvements in child mortality figures are taken out of the equation it is clear that for adults living in developed countries life expectation has certainly not risen in the way that both doctors and drug companies usually suggest.

It isn’t even possible to credit vaccination programmes with the improvement in life expectation since the figures show quite clearly that mortality rates for diseases as varied as tuberculosis, whooping cough and cholera had, as a result of better living conditions, all fallen to a fraction of their former levels long before any of the relevant vaccines were introduced.

There are real doubts, too, about the value of the drugs which doctors prescribe.

If drugs were only ever prescribed sensibly and when they were likely to interfere with a potentially life threatening disease then the risks associated with their use would be acceptable. But all the evidence shows that doctors do not understand the hazards associated with the drugs they use and frequently prescribe inappropriately and excessively. Many of the deaths associated with drug use are caused by drugs which did not need to be taken.

The best example of the modern tendency to over-prescribe probably lies in the way that antibiotics are used. One in six prescriptions is for an antibiotic and there are at least 100 preparations available for doctors to choose from. When antibiotics – drugs such as penicillin – were first introduced in the 1930s they gave doctors a chance to kill the bacteria causing infections.

The impact made by antibiotics has been exaggerated because most of the diseases which are caused by organisms which are susceptible to antibiotics were on the decline before the antibiotics were introduced.

Nevertheless, 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 and 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 and 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 doctors are under the influence of the drug companies. The makers of the antibiotics want their drugs prescribed in vast quantities. It makes no difference to them whether or not the prescriptions are necessary.

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. Penicillin alone is said to kill over 1,000 people a year and if nine out of ten prescriptions are unnecessary then it is not unreasonable to assume that nine out of ten deaths are unnecessary too. 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.’

This essay is taken from `Betrayal of trust’ by Vernon Coleman, first published in 1994 and now available again as a paperback. To purchase a copy of `Betrayal of Trust’ please visit the shop on

Copyright Vernon Coleman March 2024