The doctor who gave up drugs

[Itscurtainsforyou]

Did anyone watch this tonight?
I caught the last 40 mins (at the gym ) except for the closing minutes.

Basically saying that antibiotics, painkillers, antidepressants (among other things) are over-prescribed, do they work and what alternatives there might be.

[user1470849338]

Was trying to watch it, but kept getting distracted. I can be a bit hippy dippy and DH loves being awkward so neither of us take any tablets if we can help it. Although DH takes it too far sometimes, I had to shove a strepsil in his mouth this week when his throat was too sore to speak!

From what I saw, he was a bit smug until he realised that most people go to the doctor to get a tablet to fix them, not to be told that they're going to have to suffer through it. Found the lady with the neck pain interesting but I missed most of the one on anti-ds. Had she been on them for years? Surely she would have been referred to counselling or CBT or something after just a short while on them?

[NewBallsPlease00]

It resonated well with me; my mil is so ill due to the cocktails of drugs which need cocktails of drugs for their side effects and so it continues. She is now so low immunity through overuse of steroids and anti b she is hospitalised frequently.
10 years ago I said why do you stop taking them all, even for a couple of days to see how you feel then- her reply was 'I've taken them for a year' not I need them, or dr advises it's long term etc
she is happier taking a pill than some of the self help routes explored.
Very sadly it's now gone too far and I worry what her long term position can be 😣
I went through a phase of high anxiety and mental health stretched for a while and it was definitely exercise which pulled me through, and quickly too

And separately WTF is the nhs prescribing paracetamol which costs 17p in boots? The cost of processing that script vs self purchase is truely outrageous

[DiscoMike]

I thought that he was both unbelievably irresponsible, and had a point. My issue that his answer for everything was "no drugs" when it is never a one-size-fits-all situation.

Because, you know if anti-biotics were bad, they wouldn't save lives. I thought his face when that patient had a score of >65 on his special machine was a picture. She'd already pointed out that she'd been ill for over 10 days and really didn't think it was a virus. He'd already made his mind up that she didn't need a Rx.

[JustDanceAddict]

I'm watching it now as was out last night. I completely agree that we overuse antibiotics in particular. My dad knew this well over 30 years ago and we rarely used antibiotics. I avoid them now if I can.

[Shurelyshomemistake]

I thought it was massively irresponsible and dangerous.

The woman on antidepressants who had had two close family suicides. Exercise and cold baths... really??

[LapinR0se]

I totally agree Shurely. A while back I spent a bit of time as a day patient in a psychiatric hospital and there were quite a few v ill people there who had tried to cure themselves with juice and herbs and jogging. Sometimes you need a base of medication to stabilise you so that the juice and jogging can properly help.

[Stormtreader]

Its definitely a good idea for those people who have been stuck on a "take these pills and go away" cycle for years, but look at the effort he has to put in to help each individual person - house visits, personalised investigation and treatment plans, in-person support and skype calls to keep them motivated. Theres no way we have the resources to do that for every person now we havent been doing it for so long, theres just too many people.

[Touchacat]

I watched this and I think the ideas were interesting. But I couldn't get past what a smug, irritating twat that doctor (presenter) was. I agree with him to some extent but the way he would talk about some patients when they left the room was awful!

[Fuckoffdailymailnobs]

I was surprised that 90% of the patients on that day actually seemed to have a bacterial infection.I think the antibiotic message is actually getting through.most of those people had waited and tried to sit it out.

[Shurelyshomemistake]

Also, the woman who'd been taking overdoses of codeine-based painkillers (mixed in with the odd bout of tramadol etc) for years must have been physiologically addicted to opiates. It's not entirely plausible. It didn't seem plausible that she could just taper it off over a few days and not notice...

[Shurelyshomemistake]

The reason it pissed me off so much is because I have a family member who is not 100% converted to antidepressants yet clearly needs them to function (evidenced by many self-directed withdrawals and relapses). The narrative here would be like manna from heaven to them.

[Itscurtainsforyou]

I found the antidepressant case really interesting. She said she'd been on them 6-8 years, since she was 16 and really wanted to stop taking them.

The cold water swimming idea was based on current research at Portsmouth (I think) university - i believe it may work for some (like anything I suppose), but helped by the fact that she really wanted to stop taking them. I think there is some evidence for exercise, taking time out for yourself etc helping alleviate some depression symptoms

The woman with back/shoulder was also interesting. In my experience with back pain (& I was on oramorph so not just a twinge!) seeing a decent Physio who also did acupuncture and heat treatment helped a lot more to get rid of the pain than just pumping myself full of drugs.

I would love for my GP surgery to have that machine that measures CRP - it would give me the confidence that I'm not being fobbed off

[Pettywoman]

My cousin took himself of his meds for his serious mental illness. He attempted suicide and was left in a coma for a week and now faces a long, slow recovery if he recovers at all.

Vulnerable people who don't really have the capacity to understand the intricacies of what this programme is saying could quit much needed medication.

[annandale]

I blame Stephen Fry and his 'you can probably manage bipolar disorder without drugs in most cases' for one of my dh's numerous relapses.

Won't be watching this. I don't take tablets much but that would be because I'm not ill.

[BakeOffBiscuits]

I was a bit upset about the young mum on Ads, she needed more than cold water swims.
My own DD has been on Ads twice, both for very good reasons so I've seen for myself what an absolute life saver they are. They do work so the Dr saying the lady should have been learning "valuable life lessons" instead of being given drugs, made me really cross.

[Itscurtainsforyou]

They were quite careful to say that she would be working with her GP to slowly wean her off the antidepressants - which I hoped would come across rather than "one quick swim and she's cured". I think she'd tried to stop taking them before and had to go back on, so hopefully she's self-aware enough to recognise when she starts struggling...

I sort of agreed with the dr about his reservations for giving antidepressants out so young. I think child/young adult depression should be, where possible, tackled from all angles - talking therapies, coping mechanisms, etc and SHORT-TERM a/ds, but it sounded like she'd just been given a prescription and sent on her way.

[ablindeye]

The girl on antidepressants is clearly going to be a longer story arc, the little trailer footage suggests it's not going to be all plain sailing.

If all some people here took from it is that Van Tullekan thought she just needed "exercise and cold baths", as Shurelyshomemistake says, then the programme failed. Watch the next one, I'd say.

The point is that the girl had been taking antidepressants since she was 16. Yes she'd suffered a double bereavement, but she'd been on antidepressants for 8 years. A double bereavement is going to be devastating, but I don't think we have to accept that it inevitably means a lifetime on drugs. Antidepressants are supposed to get you through a crisis, then you rebuild your life, with support, and hopefully get well again. She'd been left reliant on them, and that's not right and it's not what she wanted.

van Tullekan was using research - not just made up stuff - that suggests that getting active is a good treatment for depression. The cold baths idea may not be mainstream, but there is evidence what it works and explanations for how it could work.

Will it work for the girl? We don't know yet.

[ablindeye]

DiscoMike:

I thought that he was both unbelievably irresponsible, and had a point. >>My issue that his answer for everything was "no drugs" when it is never >>a one-size-fits-all situation.

I thought he was clear that he wasn't anti-drugs at all. What he wanted to do is reduce the use of drugs, not eliminate them altogether.

And his experience acting as in place of a GP showed him that it was not going to be easy to reduce antibiotic prescriptions. That's was a really important and upsetting lesson, given his position (which is true) that antibiotic resistance will be disastrous (because we won't be able to treat cancer, or do any operations at all, and millions upon millions of people will die).

Because, you know if anti-biotics were bad, they wouldn't save lives.

Antibiotics are not bad. That's not his message. His message was obviously that antibiotics are good, so good that we want to be able to keep using them. But because antibiotics are overprescribed, they are becoming ineffective. Once we've lost all antibiotics, it will be armageddon. That's not an exaggeration.

You get that point, right?

So, we need to not give antibiotics to people who don't need them. We need to do this urgently. Now. Or we're in big trouble. Closing hospitals trouble. Millions die trouble. This is not science fiction, it's a real threat.

It has to stop. But the sobering truth, as demonstrated in this programme, is that actually it can't stop. Or not so easily as all that.

And the reason it can't stop is that even if doctors can resist patients begging them for antibiotics, which is hard enough, in a ten minute consultation it is not possible to determine with certainty which illnesses are caused by viruses and which are caused by bacteria. The programme pointed out that a test machine is available, but the GPs didn't like it because it cost money and time.

So that was all a shock to van Tullekan. And it should be a shock to us.

I thought his face when that patient had a score of >65 on his special >>machine was a picture. She'd already pointed out that she'd been ill for >>over 10 days and really didn't think it was a virus. He'd already made his >>mind up that she didn't need a Rx.

No, he was using a machine to test. He wanted, clearly, to reduce antibiotic prescription, and by using the machine he was able to reduce it by 10%, which is relatively good. Without the machine, he was giving them to everyone, because you can't take the risk.

That was the lesson.

It's important everyone understands the significance of this little experiment he did, because we are facing a public health apocalypse (again, this isn't an exaggeration), and he neatly demonstrated how difficult that was going to be to avoid, even for someone like him who is dedicated to trying to save antibiotics from the dustbin of history.

[GillyWilly4]

A blind eye - spot on, I absolutely agree with you. There is though a bigger problem worldwide where in some countries you can buy antibiotics in single doses. This happens. Poor people in the third world can only afford one pill in the hope that they will be cured of an infection. So even if we limit our use of antibiotics in the UK will it reduce antibiotic resistance? A promising line of research is in Antibiotic Phages which could be an alternative and combined treatment with antibiotics. They are currently using this form of treatment in Russia to treat infections and the results look promising.

[ablindeye]

Fuckoffdailymailnobs:

I was surprised that 90% of the patients on that day actually seemed to have a bacterial infection

It surprised me too, but on reflection I don't know why. What would the benchmark be?! Without the machine, they were giving antibiotics to everyone on the precautionary principle, so it was a big improvement.

Shurelyshomemistake:

Also, the woman who'd been taking overdoses of codeine-based painkillers (mixed in with the odd bout of tramadol etc) for years must have been physiologically addicted to opiates. It's not entirely plausible. It didn't seem plausible that she could just taper it off over a few days and not notice...

Addiction is defined medically as a disease. It's not the same thing as dependence. She was taking a lot, so had probably developed tolerance, but dependency involves both tolerance (you have to increase dosage to maintain effects) and withdrawal symptoms. Neither tolerance or dependence are sufficient to constitute addiction, though they are probably necessary.

I think what you have in mind is the idea that she ought to have experienced withdrawal symptoms of some kind.

But that they didn't just cut off the painkillers completely overnight and leave her to crash.

They reduced the dosage gradually over the two week period.

In other words they did exactly what you would do to come off drugs safely and without any serious withdrawal symptoms.

If she had suddenly stopped, then she might have had some withdrawal (we didn't get any discussion of this issue, though, so who knows) symptoms, but by reducing more slowly, they made sure she wouldn't.

Also worth noting that the worst of heroin withdrawal, for example, is over within a couple of days - like a dose of bad flu. Maybe that's being a bit rosy , but its basically true.

[frikadela01]

His ideas are good in theory but just aren't practical or affordable.

It all comes down to funding. Average monthly cost of citalopram is about £1.50. compare that to the cost of say a 12 week CBT programme and you can see why the prescription for antidepressants is seen as the easiest option.

Same with the antibiotics. GP surgeries have to work on a budget. £4.95 for every test or a £1.50 prescription for antibiotics just in case??

I think he would be better off looking at the issue with people have medications on repeats that they no longer need. I still have 3 medications on my repeat prescription that I only needed during pregnancy. Ive informed my gp that I don't need them anymore yet they keep adding them to the prescription.

[Itscurtainsforyou]

Frik - can you just refuse the drugs you don't want? If I get a prescription I just cross off the ones I don't want/refuse them at chemist,

[WhoAteAllTheDinosaurs]

Why don't they tackle the huge issue of antibiotic use in intensive farming worldwide? That would have a big effect on antibiotic resistance levels.
Also, Is CRP specific for bacterial infections? I didn't think it was.

[WhoAteAllTheDinosaurs]

Ah, it's not.

[frikadela01]

*it's curtains" I do cross them off. But how many people don't and just carry on getting them and just stockpiling. Or even carry on actually taking medications long after they actually need them.