Dr James Le Fanu: 15 March
Voltaire once described the medical profession thus: ‘Doctors... prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.’ He had a point, and an increasingly valid one. Whereas there were perhaps only half a dozen effective remedies in his day, now there are more than 4,000, of whose side effects even the most conscientious doctor would be hard-pressed to be knowledgeable.
In practice, most doctors have a favoured list of a couple of dozen drugs, with which they are familiar and prescribe routinely. Still, it is difficult to fully appreciate the adverse effects the drugs might have – as I was reminded when prescribed a beta-blocker for raised blood pressure several years ago.
These ‘wonder drugs’ block the action of adrenalin and are useful in a whole range of conditions, such as angina, migraine, overactive thyroid, panic attacks, and so on. Over the years, I must have prescribed them to thousands of patients, so it was interesting to note how, though they worked well enough in bringing down the blood pressure, they also left me out of sorts and lacking motivation. Not to mention the pain in my calves when exercising.
This sort of experience should, one would imagine, make doctors hesitate before reaching for the prescription pad. But on the contrary, the number of drugs prescribed in Britain has increased threefold in just 15 years, so it is now not unusual for those in their 70s and beyond to be taking half a dozen (often considerably more) different medications.
Recently, Dr Doron Garfinkel of the Shoham Medical Centre in Israel has shown that this ‘polypharmacy’ is responsible for the recognisable syndromes of tiredness, poor memory, depression and muscular aches and pains, which are often wrongly attributed to ‘getting on’.
Five years ago, he introduced a policy of discontinuing the medication wherever possible in patients with at least three separate medical conditions and successfully reduced the number of drugs they were taking by half – from eight to just over three per patient. When reviewed two months later, 90 per cent reported feeling considerably better. This might suggest the quality of many people’s lives is severely compromised by chronic medication-induced symptoms.
THIS WEEK’S MEDICAL QUERY comes courtesy of a reader in Surrey, writing on behalf of a friend recently admitted to hospital with a ‘clot on the lung’, or pulmonary embolism. She will need to take the blood-thinning drug warfarin for six months and have regular testing to ensure she is taking the right dose. She has, however, planned to spend much of that time in the South of France – what should she do?
The lady should purchase a CoaguChek, a device that allows people to monitor the bloodthinning effects of warfarin and alter the dose accordingly – all without visiting the hospital or GP. It is, however, not cheap, at around £360. drjames@lady.co.uk
New Scientist describes its mode of action as follows: ‘The herpes virus (responsible for the cold sore) needs a high humidity in order to replicate. Alcohol is a dehydrating agent reducing the water content in the tissues affected by the virus – with the result that it is incapacitated and the cold sores heal.’
In practice, most doctors have a favoured list of a couple of dozen drugs, with which they are familiar and prescribe routinely. Still, it is difficult to fully appreciate the adverse effects the drugs might have – as I was reminded when prescribed a beta-blocker for raised blood pressure several years ago.
These ‘wonder drugs’ block the action of adrenalin and are useful in a whole range of conditions, such as angina, migraine, overactive thyroid, panic attacks, and so on. Over the years, I must have prescribed them to thousands of patients, so it was interesting to note how, though they worked well enough in bringing down the blood pressure, they also left me out of sorts and lacking motivation. Not to mention the pain in my calves when exercising.
This sort of experience should, one would imagine, make doctors hesitate before reaching for the prescription pad. But on the contrary, the number of drugs prescribed in Britain has increased threefold in just 15 years, so it is now not unusual for those in their 70s and beyond to be taking half a dozen (often considerably more) different medications.
Recently, Dr Doron Garfinkel of the Shoham Medical Centre in Israel has shown that this ‘polypharmacy’ is responsible for the recognisable syndromes of tiredness, poor memory, depression and muscular aches and pains, which are often wrongly attributed to ‘getting on’.
Five years ago, he introduced a policy of discontinuing the medication wherever possible in patients with at least three separate medical conditions and successfully reduced the number of drugs they were taking by half – from eight to just over three per patient. When reviewed two months later, 90 per cent reported feeling considerably better. This might suggest the quality of many people’s lives is severely compromised by chronic medication-induced symptoms.
THIS WEEK’S MEDICAL QUERY comes courtesy of a reader in Surrey, writing on behalf of a friend recently admitted to hospital with a ‘clot on the lung’, or pulmonary embolism. She will need to take the blood-thinning drug warfarin for six months and have regular testing to ensure she is taking the right dose. She has, however, planned to spend much of that time in the South of France – what should she do?
The lady should purchase a CoaguChek, a device that allows people to monitor the bloodthinning effects of warfarin and alter the dose accordingly – all without visiting the hospital or GP. It is, however, not cheap, at around £360. drjames@lady.co.uk
SORE SITUATION
The antiviral drug aciclovir is the standard treatment for cold sores, either in the form of a cream or taken orally. There are, in addition, ‘alternative’ home remedies, including the regular application of aftershave, perfume, whisky, spirit of camphor, surgical spirit, vinegar and TCP. They share alcohol as the main common ingredients.New Scientist describes its mode of action as follows: ‘The herpes virus (responsible for the cold sore) needs a high humidity in order to replicate. Alcohol is a dehydrating agent reducing the water content in the tissues affected by the virus – with the result that it is incapacitated and the cold sores heal.’