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Tuesday, 22 February 2022

Social Prescribing. Is Conventional Medicine Losing Confidence in Pharmaceutical Medicine?

I have always equated 'Conventional Medicine' with 'Pharmaceutical Medicine' - for good reason. There has never been any good reason to do otherwise. The two are indistinguishable, certainly within most national health services around the world, and certainly within the British NHS. Go to see your doctor, or go to hospital, and the chances are you will be treated with a pharmaceutical drug, or vaccine. 

Yet are they now diverging? Just ever so slightly?

The reason for asking this question is an article published in the GP magazine, "Pulse" on 7th February 2022, "Will Covid signal the end of the road for over-medicalisation".

            "Social prescribing, also sometimes known as community referral, is a means of enabling health professionals to refer people to a range of local, non-clinical services. The referrals generally, but not exclusively, come from professionals working in primary care settings, for example, GPs or practice nurses."

Over medicalising? Does this mean that too many pharmaceutical drugs are being prescribed?

Social prescribing? Is the suggestion that doctors will actually prescribe "a range of local, non-clinical services" rather than the wonder pharmaceutical drugs they have been prescribing for decades?

The Pulse article continues....

        "Recognising that people’s health and wellbeing are determined mostly by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health."

No suggestion here that health can be found in a bottle of pharmaceutical pills! I wrote about social prescribing two years ago, in February 2020, when the UK's NHS were suggesting a greater use of "Talking Therapies" for depression and other mental health issues. More talking therapies, and less use of drugs? Was this, I asked, a tacit admission that pharmaceutical drugs were not the 'wonder drugs' we have been promised by conventional medicine for the last 100 years? Was this actually an admission that pharmaceutical drugs just do not work, that they caused more harm than good?

After all, if the drugs were really so wonderful, so effective, so safe, why would conventional medicine want to recommend using anything else?

The Pulse article recommended "a range of activities that are typically provided by voluntary and community sector organisations". Several examples were given, including volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports. 

Not a pharmaceutical drug anywhere to be seen!

Yet, social prescribing was described as capable of supporting many people "with a wide range of social, emotional or practical needs, and many schemes are focused on improving mental health and physical wellbeing"

Support, without pharmaceutical drugs! An admission that would surely never have been made a few years ago - when the drug companies were busy telling us that medical science would in some future utopia be capable of transforming our lives, and our experience of illness!

        "Those who could benefit from social prescribing schemes include people with mild or long-term mental health problems, people with complex needs, people who are socially isolated and those with multiple long-term conditions who frequently attend either primary or secondary health care."

This is a large group of people. If they can be helped by social prescribing rather than taking prescription drugs it would mean much less use of pharmaceuticals. Do the drug companies approve of such a suggestion?

Social prescribing is certainly a less harmful, more positive alternative to pharmaceutical drugs, not least in that it recognises the importance to health of social and emotional interaction with other people. But coming from a journal, one of the pillars of conventional medicine, it is not a great endorsement of the treatment it has been handing out to us, in ever-increasing quantities, for the last 100 years.

It is very clearly an admission that the drug treatments conventional medicine has been using have not been successful, that the drugs have not delivered health in the way we have all been promised for so long.

So perhaps I am going to have to be more careful in future about the distinction between conventional and pharmaceutical medicine!

Postscript 29 April 2022

Conventional medicine continues to have a crisis of confidence is pharmaceutical drugs. This time it concerns painkilling drugs.

"GP's should prescribed tailored exercise and weight loss to relieve osteoarthritis" is an article in today's 'Pulse' magazine. It announcers new NICE guidelines for the treatment of osteoarthritis, thereby continuing the trend of conventional medicine moving away (slightly) from pharmaceutical medicine.

            "Updated NICE draft guidance has placed a greater emphasis on exercise and weight loss in patients with osteoarthritis, with use of strong painkillers not advised. GPs should offer tailored therapeutic exercise, such as aerobic activity or muscle strengthening, to all people with the condition as well as consider offering education or behaviour change programmes, NICE said."

It is more specific about the non-use of painkilling drugs.

            "Pharmacological treatments should be used at the lowest effective dose for the shortest possible time and topical NSAIDs should be the first choice for joint pain due to the condition. Paracetamol and glucosamine should not be routinely offered, strong opioids should not be used and weak opioids only used for short-term pain relief and when all other drug treatments are contraindicated, not tolerated or not effective."

Whether this will make any difference of how doctors treat osteoarthritis may be doubtful, but this constitutes yet another admission - that pharmaceutical drugs are not effective in the treatment of osteoarthritis.