A study of over-prescription for depression and anxiety deserves analysis because it contains a mix of truth… and hidden agendas
GPs are turning us into a nation of pill-poppers, according to shock headlines last week. The research, commissioned by the charity Nuffield Health, found that GPs are 46 times more likely to prescribe medication for depression and anxiety ”rather than recommend other, medically proven alternatives such as exercise’’.
This feeds in nicely to the social narrative surrounding primary care: that GPs are too busy and harassed to listen and are only interested in pushing us out of the door clutching a prescription to keep us quiet. Dr Davina Deniszczyc, the medical director of Nuffield Health, said: ”The compelling evidence that physical activity can play an important role in both treating and alleviating early symptoms of mental ill health isn’t sufficiently filtering through to front-line and primary care services.’’
This study deserves a closer analysis because it contains a mix of truth… and hidden agendas. The newspaper reports indicated, correctly, that it was commissioned by a charity. But although Nuffield Health is technically a charity, it is actually a private hospital chain. It was criticised when it emerged that the group paid only £100,000 corporation tax in 2011, despite a turnover of £575 million, because of its ”charity’’ status. Its chief executive, David Mobbs, has a salary package of £860,000. It has 31 hospitals but also 60 membership gyms. So, a cynic could argue that it has a vested interest in, firstly, undermining people’s confidence in GPs and, secondly, commissioning research that promoted exercise. The study is, in essence, a nicely dressed up piece of covert marketing.
And it works as a marketing message because it does contain some truth. I should emphasise that I routinely prescribe antidepressants to patients with moderate to severe depressive illness, and they are effective. It is also true that sometimes antidepressants are prescribed to people for whom exercise would be beneficial, such as those with a mild depressive illness. But for many, their depression is so severe that the idea of a brisk jog in the park to lift their spirits is absurd. It can be a life-threatening illness that deserves prompt pharmacological intervention.
However, what the study failed to explore was why GPs were so ready to prescribe antidepressants. The real story here is about psychological therapy services. Historically, GPs have been reliant on antidepressants because access to the alternative – the ”talking therapies’’ – in the NHS is subject to very long waiting lists.
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The doctors concluded that many of the “cures” are a result of the placebo effect, when patients’ bodies heal themselves because the patient is convinced they have been given a miracle remedy.
“Even when people have three doctors telling them their treatment has no medical benefits, once they are in that zone, believing in their remedy, they won’t be persuaded otherwise.”
In the test, all of the people given duct tape found their verrucas shrank by at least one millimeter, whereas none of those who used surgical tape saw any difference at all.
Dr Cannon said: “I’ll certainly suggest to my patients that they give it a try if they aren’t having any success with other treatments.”