Asthma. Why do doctors not follow official guidelines on treating this condition?

Some time ago NICE (the UK's National Institute for Health and Clinical Excellence) recommended that doctors stepped down the use of asthma drugs in what they described as 'stable patients'. This was sensible advice given. They said, quite clearly, that there was no benefit in giving more drugs, more inhalers, as they could cause serious adverse effects; and reducing them would save the NHS money.

However, MIMS has now reported (July 2020) on new research that has shown this is not happening in practice - despite all the benefits of greater patient safety, and cost.

Instead, patients with asthma are increasingly being prescribed 'higher-level' treatment, often without clear clinical need, and a large proportion never have their medication stepped down - despite the clinical and cost benefits of doing so. These are the findings of UK research undertaken between 2001 and 2017. As MIMS reports:

               "They found that prescriptions of higher-level medication, such as medium- or high-dose inhaled corticosteroids, or inhaled corticosteroids with add-on medication such as long-acting ß2-agonists (LABAs), increased from 49.8% in 2001 to 68.3% in 2017. Among patients prescribed their first preventer, one third were prescribed a higher-level medication. Half of these had no reliever prescription or asthma exacerbation in the preceding year, suggesting the prescribers were not following clinical guidelines. Of the patients first prescribed inhaled corticosteroids with one add-on treatment, the majority (70.4%) remained on the same medication during a mean follow-up of 6.6 years."

What is worse the research found that 1 in 8 patients (13%) who were prescribed medium or high dose inhalers already had conditions that could be worsened by corticosteroids, such as diabetes, glaucoma or osteoporosis. So is this gross negligence by doctors?

Conventional medicine is allowed to peddle pharmaceutical drugs and vaccines that have serious adverse effects, that can cause serious patient harm, chronic disease, and death. And it might be expected, this being so, that doctors would take great care to follow the official guidelines on their prescription.

Yet unfortunately for patients (those who continue to place their trust in pharmaceutical medicine) this is often not the case. And it is so not just in this case of these asthma guidelines. In the same edition of MIMS, they reported that doctors should not prescribe analgesics for chronic pain.

Doctors will also ignore this guidance. How do I know? Doctors have nothing else to prescribe! They may be aware that paracetamol, ibuprofen, other NSAID painkillers, benzodiazepines and opioids should not be offered to people with chronic primary pain "because there is little evidence that they made any different to people's quality of life, pain, or psychological distress"; but when they are faced with a patient in chronic pain they will almost certainly continue to prescribe them. They will find it hard to tell a patient in pain that there is nothing they can do, nothing they can offer. So take the painkillers, and when they don't work, when they make the pain worse, come back and see me again. At least it gives the doctor a few week's grace. They have done something!

This is where conventional medicine now finds itself. The drug cupboard is bare. Doctors can prescribe few drugs (if any) that are safe. Or few drugs that make any significant difference to patients who are sick. And this applies to all illnesses. We are witnessing the failure of conventional medicine.

So rather than admit failure, doctors continue to prescribe the same old failed and harmful pharmaceutical drugs.

NICE will continue to provide guidelines for doctors about the drugs they cannot prescribe, albeit belatedly for the patients who have already been harmed by them. But they cannot tell doctors what they should be doing instead - because they have no alternative.