PAINKILLING DRUGS. How is conventional medicine coping with the crisis arising from their failure?

I was writing about the failure of painkillers 2013, 7 years ago - on this very day! My blog, 'The Failure of Painkilling Drugs' arose after I read an article in the GP e-magazine, Pulse, in which a doctor asked an important  question - what have GP's been left with to treat patients with chronic pain?" The article stated:

          "... GP options for managing persistent pain in their patients have declined markedly over the past decade, but it seems we may have finally reached crisis point".

The story in 2013 was that all the main painkilling drugs were known to cause so much damage to patients, and had so many restrictions placed on prescribing them, doctors had nothing left to give patients suffering long-term pain.

So what has happened over the past 7 years? How has conventional medicine responded to this self-declared crisis? The answer can be found in this recent Pulse article, dated 28th August 2020, entitled "Proposed Ban on Opioids for chronic pain leaves GP's with scant options".

So the answer is clear - nothing has happened over the last 7 years!

The 2013 article had doctors expressing concern about the bare medicine cupboard. Since then there have been no new painkilling drugs. Sp doctors continue to prescribe the same old drugs, in full knowledge of their ineffectiveness, and their dangers to health. They have been prescribing more opioids, which has led to the disasters in the USA, Europe and elsewhere. But essentially, doctor continue to do what they have been told not to do for the last 7 years - and more. They remain in the same position.

The reason for the 2020 article in Pulse was that NICE (the National Institute of Clinical Excellence) reported that there was a lack of evidence for the effectiveness of opioids, along with evidence of long-term harm. It was this that had persuaded them to recommend against the prescription of opioid drugs for people in chronic pain. So they advised doctors to stop prescribing opioids. 

The guidance, however, went much further, stating that all the other main painkilling drugs were now considered too harmful to prescribe to patients:

               “Do not offer any of the following, by any route, to people aged 16 years and over to manage chronic primary pain; opioids; non-steroidal anti-inflammatory (SSRI) drugs; Benzodiazepines;anti-epileptic drugs including gabapentinoids; Paracetamol; Ketamine; Corticosteroids and antipsychotics” 

So what, we might ask, can doctors prescribe to people in long-term pain? In other words, what is the answer to the question doctors were already asking, 7 years ago? There is, of course, nothing. Conventional medicine has absolutely nothing to offer.

Earlier, Public Health England had undertaken a review into prescription drug addiction, revealing that about 1 in 4 adults (about 11 million people in England alone) had a prescription for antidepressants, opioids, gabapentinoids, benzodiazepines; and that admissions to rehabilitation facilities for prescription drug addiction had risen by about 40% in the last 18 months.

This encapsulates the performance of what we call our 'National Health Service', a 'service' on which we are being repeatedly being asked to spend more money, year by year - a health service that can offer people in pain only dangerous failed drugs.

Nice estimated that between one-third and half of the population may be affected by chronic pain while almost half of people with the condition have a diagnosis of depression and two-thirds are unable to work because of it.

The conventional medical establishment, which now operates a monopoly within the NHS, has no effective treatment capable of dealing with this ever-growing epidemic of long-term pain.

So what will the situation be in another 7 years time? I predict that doctors will still be prescribing the same old failed drugs, all mentioned above; that the epidemic of long-term pain will have increased; and that some conventional health body will again provide doctors with more guidance - they should not be prescribing these same drugs to patients. And that doctors will continue to ask, despairingly, what else can they do?

There is only one sensible answer - to move to natural medical therapies, to join an increasing (but still small) number of patients who are already doing so. And perhaps it is worth pointing out that no-one has to wait another 7 years in order to do so.

  

Painkillers. Doctors told they are not safe for patients. But will patients be told?

Our doctors have been bemoaning the fact that painkillers do too much harm to prescribe safely. One doctor wrote honestly about "the vanishing option for chronic pain' in the GP e-magaizine, Pulse, in September last year.

          "... GP options for managing persistent pain in their patients have declined markedly over the past decade, but it seems we may have finally reached crisis point".

NICE, the National Institute for Clinical Excellence, has now confirmed this position, issuing new guidance for the prescription of painkilling drugs. Pulse has reported on this in it article 'NICE dramatically reduces drug options for low back pain', (24 March 2016).

          "The draft guidelines – which now also cover sciatica – said that GPs should offer NSAIDs as first-line for pain relief, and should offer paracetamol only alongside a weak opioid."

Although this is a clear indication that conventional medicine is failing, disastrously, NICE cannot avoid taking a swipe at traditional medicine, this time Acupuncture, saying that GPs "should avoid acupuncture altogether - which ..... is no better than sham treatment". Well, perhaps patients should be allowed to make their minds up about this, although it has to be recognised that NICE is firmly part of the conventional medical establishment, and supporters of the pharmaceutical industry.

Instead NICE recommends exercise, such as stretching, strengthening, aerobics or yoga "to be the first step to help patients manage their condition". Clearly, the drugs cabinet of conventional medicine is becoming increasingly bare!

Yet it is the comments on the Pulse article that is perhaps most interesting. As far as doctors are concerned, the response varies from despair to denial. Yet one feature of GP comments appear to show some misunderstanding of what is actually happening. There is some sense that NICE are making their life difficult for them, that the new guidance is either misguided or incorrect. One comment reminds us that all the painkillers doctors can no longer freely prescribe can be purchased at chemists at a cost far lower than a prescription.

All this misses the essential truth behind the new guidance. NICE have recognised that conventional painkilling drugs are not safe. They are harmful. They are dangerous.

Nowhere can I see significant concern for patient health. Nowhere can I see doctors asking how they can protect patients, or whether they should stop prescribing or recommending painkillers. Nowhere is the question asked - 'if painkillers are too dangerous for doctors to prescribe, why are the still on sale at chemist shops?"

As might be expected, the 'medical fundamentalists' have entered the argument, but they only to focus on the attack on Acupuncture, and do not mention the dangers of conventional painkilling drugs.

• Andy Lewis appears to think that acupuncture has not been used for for thousands of years (which makes me wonder where he has been for all that time)! His claim is refuted by Tony Gu, who correctly says that "it has a fairly reasonable evidence base"! Yes, indeed it has! An evidence base that stretches back thousands of years!
• David Colquhoun states that "the results of more than 3000 trials of acupuncture ... have consistently shown that (acupuncture) is indistinguishable from various sorts of sham, yet some people still advocate it".  These trial are, of course, 'randomised controlled tests', and RCTs are the tests that told us initially that painkilling drugs were safe and effective.
• In another post Colquhoun says he is 'heartened' by the new guidance because "the fact is that none of the treatments works very well and that has led to clutching at straws". So this conventional medical fundamentalist professor is heartened that we are 'clutching at straws' - a dispiriting and defeatist comment indeed.

 At least Colquhoun is correct here. It is a dispiriting time for supporters of conventional medicine, on which society has placed so much trust, and spent enormous resources, during the last 70 years and more. It is dispiriting for patients. And it must be dispiriting for professors, sitting in their university faculties, largely funded by the pharmaceutical industry.

Patients are needing some positive guidance, and this will not come from the conventional medical establishment. It will come from traditional therapies, including acupuncture, osteopathy, chiropractic, homeopathy,  and many others. At least these treatments are not dangerous. And patients will increasingly seek and use these therapies because their doctors have nothing to offer. And they will find that they do work - just as millions of patients throughout the world over centuries have told us!

Statin Drugs. Doctors conflicted about their safety?

The conventional medical establishment appears to be conflicted over Statin drugs. The National Institute for Health and Care Excellence (NICE), which provides doctors in Britain with advice and guidelines about prescribing drugs recently advice an increase in Statin prescribing. Whereas previous advice was to prescribe them to any patient who had a 30% risk of a heart attack or stroke, they changed that advice to anyone who had a 10% chance.

This would have meant a considerable increase in the number of people taking Statins, particularly amongst older people. NICE said that it would prevent 28,000 heart attacks, and 16,000 strokes every year. So, something worth doing?

Well, unfortunately, doctors did not think so. A recent analysis by the GPs' magazine, Pulse, discovered that since the new NICE guidelines were given, prescriptions for statin drugs had shown only a 2% rise.

So why the discrepancy? Is there increasing conflict within the conventional medical establishment about Statins? And if so, what is the conflict about?

The problem concerns the safety of Statin drugs. Once, not many years ago, conventional medicine was telling us that these were miracle drugs, reducing heart attacks and strokes, but with little or no side effects. They were, we were told, entirely safe.

Indeed, it is that type of blue-sky thinking that underlay NICE's amended guidelines to doctors. The reason for this is not difficult to find. NICE, like most government sponsored health advisory bodies, is influenced, infiltrated and dominated by medics who have strong links with the powerful pharmaceutical companies. Therefore, most of NICE's advice is driven by the interests of these companies, whose major objective is to sell drugs to patients.

Yet the dangers of Statins is becoming increasingly obvious to an increasing number of people. There is growing numbers of people who are reluctant to take Statin drugs. Doctors meet with people every day. They are aware of this growing concern. And they cannot be unaware of the very serious evidence that is building against these harmful drugs.

In 2014, the Medicines and Healthcare Products Regulatory Authority (MHRA) reported that it had received 730 adverse reports related to the five most prescribed Statins in Britain, namely Simvastatin, Atorvastatin, Rosuvastatin, Pravastatin and Fluvastatin. Yet it is well known that only about 10% of adverse reactions to drugs are reported - this, in itself, probably an underestimate. What this means is that in one year, in Britain, over 7,000 patients has been damaged by Statin drugs.

What damage is it causing? The side effects of Statins are now known to include:

• Muscle pain, weakness (myopathy).
• Fatigue.
• Cataracts.
• Weight gain.
• Diabetes
• Kidney failure.
• Liver dysfunction.
• Memory loss, confusion and dementia.
• Parkinson's disease

This is a frightening list of serious illness and disease, all possible outcomes for patients who are taking these 'entirely safe' Statin drugs.

Concerns have also been expressed that the benefits of taking statins have been greatly exaggerated. Some research has questioned whether Statins can reduce the risk of heart attacks and strokes to the levels claimed.

Doctors are at the very end of the drug consumption line. They deal with patients who are taking them, and suffering from them. Little wonder, then, that some doctors have expressed concerns about the benefits of taking statin drugs, certainly for people who are healthy.

So why are doctors ready to defy NICE's new recommendations on Statins? GP's and NICE has different motivations and priorities. If NICE wants more people to take drugs, in the interests of the pharmaceutical industry, regardless of the harm they do to patients, the role of doctors is to put patient interests first. Perhaps it is unusual for them to do so. Doctors have been prescribing harmful and dangerous drugs to patients now for decades on the basis of the guidance and advice they have received. And, in the main, they have done so without serious questioning.

So is there change happening within the conventional medical establishment? Are doctors beginning to take a more independent line? Are they beginning the question some of the advice and guidance coming down from the pharmaceutical industry?

It would appear, in this case, to be what is happening. It is a real signs of conflict and disagreement within the conventional medical establishment. Whilst the production and management end continues to maximise the use, and over-use of harmful drugs and vaccines, the retail end is at least beginning to question the value of this single, but extremely important drug.

Can we expect more? Possibly. It is certainly time that the value of many other drugs and vaccines, whose harm and dangers are well known to anyone prepared to look, are seriously questioned.

Yet there is a problem with our doctors. If they did begin to question the value of drugs and vaccines more widely, what would they have left to offer patients? Conventional doctors have dismissed alternative medical therapies. They do not speak out sufficiently about the processed diets being served up to us by supermarkets and the Big Food companies. They are not on board, sufficiently, with the importance of exercise, or the environment concerns that affect our health. Their cupboard, without drugs, would be bear.

Real change will still have to come from patients, not doctors, who in order to tell us the truth will have to admit that they have been giving us 'medicines' that have made us ill for years! More people will have to become aware of the dangers of conventional medical treatment. More people will have to become aware that there are other routes to good health, and other medical therapies available that are safer, and more effective than what the conventional medical establishment are providing to us.

It is still going to be a long, laborious process. We have been indoctrinated by the conventional medical establishment for over 100 years. It will take time to understand that health does not come from a pill or an injection.

Big Pharma's snout at the feeding trough!

Some Big Pharma drug companies are annoyed, and are threatening to take the British government to court. The problem? They may be denied access to a large pot of NHS money.

The government set up the 'Cancer Drugs Fund in 2010, one of its first acts following their election, to provide extra funding for medicines that were considered 'too expensive', and 'poor value for money' by NICE, and so could not be prescribed within the NHS. £200 million was set aside. This has risen to £280 million. And apparently the fund is already overspent by £30 million this year.

Does that sound generous? Well, apparently not generous enough for the Big Pharma companies. Two drug companies are threatening to take the government to court because their drugs are being 're-assessed'. Their feeding frenzy at the NHS feeding trough is being threatened!

Just how arrogant is this? Public money is being spent on ludicrously expensive drugs, and the drug companies object to a decision that seeks to ensure that taxpayer's money is being spent appropriately! They must assume they have some kind of 'right' to the money being spent on their drugs. And that our government has not responsibility to make decisions that are detrimental to their profitability.

Of course, that is not the way they put it, or how our meek mainstream media is describing it. The government is denying patients access to 'life-saving' drugs (according to the BBC), or, if you prefer the 'Mail Online',

"Thousands of women with advanced breast cancer are set to be denied ‘last chance’ medication that can give them extra months, if not years, with their loved ones".

Although the Media is sufficiently honest to point out the costs of these drugs, up to £90,000 per year per patient, little or nothing was said about the safety of effectiveness of the six drugs, Eribulin, Avastin, Kadcyla, Afinitor, Tyverb and Perjeta. So let's consider just one of these, Avastin, and consider it's history.

Avastin was approved in February 2004 by the FDA, the US drug regulator. Within 5 months, however, it discovered that the new 'wonder drug' could cause stroke, heart attacks, angina, and double the risk of a fatal blood clot. Apparently, even when it was approved, Avastin was known to  cause fatal stomach perforations and congestive heart failure. The situation only got worse, though.

• Avastin has been found to cause 'potentially fatal' brain inflammation.
• Avastin has been found to cause blindness.
• FDA withdraws approval for Avastin, declaring it medically useless, but doctors still allowed to prescribe it (a useless drug)!
• NICE finds that Avastin is 'Too Expensive' For NHS (August 2014) 

So, it would seem that what is being 'denied' to 'thousands of women with advanced breast cancer' is a 'life saving' drug that is exorbitantly expensive, dangerous to our health, and useless too!

Does that sound like a good deal? Well, it is good enough for the drug companies. And apparently it is good enough for our mainstream media, including the BBC, who continue to refuse to tell us the truth about conventional drugs and vaccines.

I suppose we are just expected to believe the passive and unquestioning promotion of pharmaceutical drugs, take it when they are given to us regardless of their affects on our health, and pay exorbitantly for the privilege!

Anyone want to stop jumping to Big Pharma's tune?

NICE Chair criticises RCTs

Sir Michael Rawlins has been chairman of the National Institute for Health and Clinical Excellence (NICE) since its inception in 1999. He has attacked traditional ways of assessing medical evidence, particularly for pharmaceutical drugs.

http://www.politics.co.uk/opinion-formers/press-releases/royal-college-physicians-sir-michael-rawlins-attacks-traditional-ways-assessing-evidence-$1245035$365674.htm

In particular, he is critical of Randomised Controlled Test (RCT's), for so long the main totem for homeopathy denialists, and the chief means of testing pharmaceutical drugs. Sir Michael outlines the limitations of RCTs in several key areas:

# Impossible - for treatments for very rare diseases where the number of patients is too limited.

# Unnecessary - when a treatment produces a "dramatic" benefit - imatinib (Glivec) for chronic myeloid leukaemia.

# Stopping trials early - interim analyses of trials are now commonly undertaken to assess whether the treatment is showing benefit and if the trial can be stopped early. Around 30% of recent trials in oncology have been stopped early for apparent benefit. Although the desire to stop trials early is understandable, the possibility that an interim analysis is a "random high" may be difficult to avoid - especially as there is no consensus among statisticians as to how best to handle this problem.

# Resources - the costs of RCTs are substantial in money, time and energy - a recent study of 153 trials completed in 2005 and 2006 showed a median cost of over £3 million and with one trial costing £95 million. One manufacturer has estimated that the average cost per patient increased from £6,300 in 2005 to £9,900 in 2007

# Generalisability - RCTs are often carried out on specific types of patients for a relatively short period of time, whereas in clinical practice the treatment will be used on a much greater variety of patients - often suffering from other medical conditions - and for much longer. There is a presumption that, in general, the benefits shown in an RCT can be extrapolated to a wide population; but there is abundant evidence to show that the harmfulness of an intervention is often missed in RCTs.

Far better, perhaps, to rely on a medical therapy like homeoopathy, with its long history of effective treatment, and safety.