Positive Health Online

In the UK, where most people rely on healthcare paid for by the taxpayer and delivered via the NHS, we spend about 8.1% of our GDP on healthcare. Americans, on the other hand, who pay out of their pockets and through insurance companies, spend almost double this – 15.4% of their GDP.[1]

What is being done with all this money? The journal BMJ Clinical Evidence exists to inform researchers and doctors about the state of the evidence base for medicine. Of around 2,500 commonly used medical treatments evaluated so far, a mere 13% have been shown to be beneficial, with a larger 23% likely to be beneficial. Eight percent are considered a trade off between benefits and harms, six percent unlikely to be beneficial, four percent likely to be ineffective or harmful, and 46%, the largest proportion, as unknown effectiveness.[2] The fact that nearly half the commonly used medical treatments are of unknown effectiveness is an irony, given that orthodox medicine’s most consistent criticism of Complementary and Alternative Medicine (CAM), is lack of adequate evidence of efficacy.

Dr Allen Roses, Vice President of Genetics at Britain’s largest drugs company, GlaxoSmithKline, famously said in 2003, “The vast majority of drugs – more than 90% – only work in 30% or 50% of the people… I wouldn’t say that most drugs don’t work. I would say that most drugs work in 30% to 50% per cent of people.” Dr Roses’ comments were made at a scientific meeting in London just days after it was revealed that the NHS drugs bill had risen by nearly 50% in just three years – £2.3 billion a year to an annual cost to the taxpayer of £7.2 billion.[3]

When we explore the peer-reviewed literature and look at causes of mortality in western, industrialized countries, we also see some worrying trends.

Lazarou and colleagues determined, following a meta-analysis of other studies, that 6.7% of hospital patients in the USA suffered serious adverse drug reactions (ADRs) from correctly prescribed medicines, while 0.32% suffered fatal ADRs.[4] This latter figure amounts to 106,000 Americans being killed annually by properly prescribed drugs. Zhan and Miller showed that medical injuries and post-operative infections in hospitals caused the death of some 98,000 Americans annually.[5]

Adding just these two sources of death, gives us 204,000 deaths a year. This puts adverse drug reactions and medical injuries firmly as the third leading cause of death, following heart disease and cancer respectively [see CDC figures].[6]

On this basis, we can hardly sit back on our laurels and believe our direction in healthcare is delivering the goods. Our healthcare system is excessively drugs dependent, and the over seven billion pounds they cost us and, the more than 650 million prescriptions written by GPs each year,[7] are not doing us as much good as many think. Our healthcare system is plainly unsustainable, and the biggest problem we have is that governments and industry seem unprepared to recognize this.

Lack of sustainability is almost certainly primarily the result of excessive control of healthcare by the pharmaceutical industry, which controls around 65% of all health-related research.[7]

At the ANH (Alliance for National Health), we are developing criteria that can be used to define sustainable healthcare. We believe that, just as with other damaging industries, we need to use specific criteria to assess sustainability of the key approaches to healthcare to allow future prioritization by providers, governments and, of course, recipients of healthcare. The criteria include the contribution of a particular approach to quality of life, its overall cost (including the cost of side-effects), and the benefits likely to be incurred. Under this new paradigm, it is perhaps no wonder that preventative healthcare based on diet and lifestyle changes, as well as many of the modalities that sit under the CAM banner, appear much more sustainable than many drugs based approaches.

It is also no surprise, for those of us with an ecological perspective on life, that current so-called CAM practices are an extension of those that have been practised for millennia. They have evolved alongside our species, and have been largely accepted or rejected on the basis of observational evidence (yes, not randomized controlled trials). To regulate such practices out of existence, an objective that appears to be high on many governments’ agendas, on the basis of lack of evidence or potential harmfulness is irrational, discriminatory, legally disproportionate… and just plain stupid. Sustainable healthcare, just like sustainable energy, agriculture and forestry, is now a necessity for our, and our planet’s, long-term survival. To bring about the paradigm shift, we need to make existing knowledge more readily available to the majority of the population and to lessen the control of our healthcare system from a small number of powerful corporations who have undue influence over governments.

Editor’s Comment

Amen!

References

1.    Statistics derived from www.nationmaster.com. Based on 2004 figures.
2.    BMJ Clinical Evidence website: http://clinicalevidence.bmj.com/ceweb/about/ knowledge.jsp
3.    Connor S. Glaxo chief: Our drugs do not work on most patients. The Independent. London. 3 December 2003.
4.    Lazarou J, Pomeranz B and Corey P. Incidence of adverse drug reactions in hospitalized patients. JAMA. 279: 1200-1205. 1998.
5.    Zhan C and Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 290(14): 1868-74. 2003.
6.    Centres for Disease Control, National Vital Statistics Reports. Vol. 55. No. 19. 21 August 2007.
7.    House of Commons Health Committee. The Influence of the Pharmaceutical Industry. 126pp. House of Commons. London: The Stationery Office Limited.