Editorial Note: No one outside the UK may be paying any heed to the all-consuming debate within Britain about the referendum on the future of Scotland. Everything comes back to this. Corporations have been saying they’ll pull out if Scotland leaves the UK (Standard Life) or that they’d prefer if Scotland left (British Airways). The EU have said Scotland would have to wait 5 years to apply to join the EU – until they had proved they could make a go of it alone – but haven’t said the same thing about a newly independent England.
So it’s time for RxISK.org to make clear its position on Scottish independence. Take the test and then see below.
The Macbeth test
Be these juggling fiends no more believed
that palter with us in a double sense
keeping the word of promise to our ears
but breaking it to our hope
A medical Macbeth has overthrown the gentler and wiser Duncan. As things go badly wrong he will always opt for more of what caused the problem rather than trying to step back.
At the behest of the Witches, he uses guidelines and screening tests. But the guidelines are for diseases rather than people and the screening tests create rather than solve problems.
This test to detect the influence of the Witches works on the premise that we should treat people not diseases:
1. You should not be on more than 5 medicines other than in exceptional circumstances.
Score -2 if you’re on nothing, 0 for 1-4 meds, +2 for 5-8 meds, +5 for 8 or more meds.
2. Your doctor should acknowledge that neither he nor anyone has access to the full dataset on any drug he prescribes.
Score -2 for acknowledgment of this.
Score +2 if he insists he prescribes according to good evidence.
3. Your doctor should treat you and not your measurements. Excellent treatment would have minimal or no measuring in the course of treatment.
Score + 2 for each test from Box A.
Score -1 for any tests from Box B.
4. The complaint/problem you bring to your doctor should be the focus of treatment, not some problem your doctor tells you you have.
Score -1 for each problem you brought to the doctor.
Score +2 for each problem your doctor said you have.
5. You should only take treatments that are proven to save lives – most treatments aren’t.
If your doctor can prove your treatment saves lives score -1.
If he says he is treating a risk factor score +2.
6. Treatment should improve your ability to function not laboratory measurements.
Score -1 if you are able to do more on treatment.
Score + 2 if you are able to do less.
7. For each treatment you are on from Box C or D below Score -1.
For each treatment from Box E, Score +2.
9. You have a right to ensure your doctor is not treating you to meet s target set by his employers, a guideline committee, or the government.
Score +5 if your doctor has called you in for a screening program or you suspect you are doing more for him than he is for you.
10. Many people need less than the ‘usual dose’ to get a good effect. A prescriber who starts on a lower than ‘usual’ dose and watches what happens is a good prescriber.
Score -2 if your doctor starts you on half the lowest dose or uses older medications in low doses.
Score +2 if your doctor goes beyond the recommended highest dose.
11. In older age you need to be treated like a vintage wine – with care. You are more susceptible to side effects and interactions. Get your doctor to take the birthday test: Each birthday ask him ‘which drugs can I stop?”.
Score -2 if he stops one or more.
Score 0 if you are on only 1 or 2 tablets to begin with.
Score +2 if he refuses to accept there are any drugs you could stop.
12. Don’t take drugs for diseases you don’t have.
Score -2 if your doctor has not attempted to give you a disorder from Box F.
Score +2 if you have been given a diagnosis from Box F.
13. Your doctor should be worried that you have all the information you need to choose and not worried by your choice.
Score -2 if your doctor supports you in decisions to avoid treatment.
Score +2 if your doctor finds it difficult to accept your choice.
Score +5 if he attempts to do a Mental Capacity Test on you.
14. The bigger the number of people entered into trials of your treatment the less helpful this treatment is likely to be.
Score -2 if the main trials on your treatment had less than 100 people in them.
Score + 2 if the trials had over 100 and less than 1000 people in them.
Score + 5 if the trials had over 1000 people in them.
We would until recently have said “if your doctor scores more than 10 on this test, consider leaving Scotland – unless of course you attend his or her clinic for the scenery rather than the advice”. But Westminster seems to be where the Witches are based at the moment, so perhaps consider getting a doctor from North of the Border if the Scottish Government comes up a good plan to escape the new Tyranny that is leading to the destruction of Medicine as it once was.
Box A: Problematic measurements
- If healthy – any measurement including any rating of behavior
- Mood rating scales in children
- Screening for Prostate Specific Antigens (PSA test)
- Screening for Bone Densities
- Routine Cholesterol Levels in the absence of Cardiovascular Risk Factors
- Screening for HbA1C/glucose levels if not diabetic
- Regular Peak Flow levels
- Depression Screening in Pregnancy
- Mammography under 50 without a family history
- Troponin T measurements
Box B: Helpful measurements
- Cholesterol levels after a heart attack
- Colon cancer screening if a positive family history
- Cervical Smears
- Neonatal screening for PKU, or thyroid problems
- HIV screening
Box C: Life saving treatments
- Coal Tar for Strychnine and other Poisoning,
- Parachute for Sky Diving
- Insulin for Type 1 Diabetes
- Inhalational anesthetics for surgery
- Gentimycin for Bacterial Endocarditis
- Antibiotics (Penicillin) for Bacterial Meningitis
- Thiazide antihypertensives for Severe Hypertension
- Glivec for Lymphoma/Teratoma
- Statins for Familial Hypercholesterolemia
- ARVs for AIDs
Box D: Function restoring treatments
- Thyroxine for clinical hypothyroidism (not for borderline laboratory abnormalities)
- Benzodiazepines for catatonia
- Tricyclic Antidepressants for Melancholia;
- Antihistamines for allergies
- Stimulants in cases of gross hyperactivity
- Phosphodiesterase inhibitors in impotence
- Anti-malarial prophylaxis (Not Lariam)
- Folate pre-pregnancy and in first trimester
- Morphine for pain relief
Box E: Treatments where the harms are likely to outweigh the benefits
- Aspirin for prevention of heart attacks
- Extended course of HRT
- Statins for cholesterol elevation in the absence of other Cardiovascular Risk Factors
- Biphosphonates for Osteoporosis
- Long Acting Beta Agonists given alone for Asthma
- SSRI Antidepressants if continued without a clear beneficial response,
- Varenicline, Buproprion for Smoking Cessation
- Antipsychotics for Treatment resistant Schizophrenia
- Drug treatment for Lung Cancer
- Drug treatment during first term of pregnancy
- Antipsychotics in the elderly
- Weight loss drugs
Box F: Diagnoses that put your life at risk
- Pre-hypertension
- Pre-diabetes
- Osteopenia
- Female Hypoactive Sexual Desire Disorder
- Complicated Mood Disorder
- Sub-Syndromal Depression
- Juvenile Bipolar Disorder
- Psychosis Proneness
- Sub-optimal Peak Flow Disorder
- Raised Cholesterol Levels in the absence of other cardiovascular risk factors
- Adult ADHD
- Adult onset Autistic Spectrum Disorder
Not to mention the vaccine schedule:-
2 months:
5-in-1 (DTaP/IPV/Hib) vaccine – this single jab contains vaccines to protect against five separate diseases: diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib, a bacterial infection that can cause severe pneumonia or meningitis in young children)
Pneumococcal (PCV) vaccine
Rotavirus vaccine
3 months:
5-in-1 (DTaP/IPV/Hib) vaccine, second dose
Meningitis C
Rotavirus vaccine, second dose
4 months:
5-in-1 (DTaP/IPV/Hib) vaccine, third dose
Pneumococcal (PCV) vaccine, second dose
Between 12 and 13 months:
Hib/Men C booster, given as a single jab containing meningitis C (second dose) and Hib (fourth dose)
Measles, mumps and rubella (MMR) vaccine, given as a single jab
Pneumococcal (PCV) vaccine, third dose
2 and 3 years:
Flu vaccine (annual)
3 years and 4 months, or soon after
Measles, mumps and rubella (MMR) vaccine, second dose
4-in-1 (DTaP/IPV) pre-school booster, given as a single jab containing vaccines against diphtheria, tetanus, whooping cough (pertussis) and polio
Around 12-13 years:
HPV vaccine, which protects against cervical cancer (girls only) – three jabs given within six months
Around 13-18 years:
3-in-1 (Td/IPV) teenage booster, given as a single jab which contains vaccines against diphtheria, tetanus and polio
Around 13-15 years:
Meningitis C booster
65 and over:
Flu (every year)
Pneumococcal (PPV) vaccine
70 years:
Shingles vaccine
http://www.nhs.uk/Conditions/vaccinations/Pages/vaccination-schedule-age-checklist.aspx?tabname=NHS%20vaccination%20schedule
Scotland
Cons: It has not stopped raining for 300 years
The mighty midge keeps feeding on us all summer
Pros: There are not many people here
England
Cons: Cons
Pros : Pros
The latest PIL from the English Conglomerate, GSK, reads like a script out of the Rocky Horror Show.
Freely available on GSK website along with their transparency issues.
Along with the millions Sir Andrew Witty earns, per annum.
Not much about forecasts with inbuilt legal fines such as a few billion, here and there.
I know companies like GSK in their PIL writing department, with a lawyer looking over their shoulder, have to cover all angles, but, a prescriber, today, writing a prescription for Paroxetine, has to be some sort of sadist.
He/she should be hung, drawn and quartered allowing any innocent party to become hung, drawn and quartered by swallowing Paroxetine.
The PIL in my box in 2000 was more like A Midsummer Night’s Dream, than, Macbeth. But, it came to pass that murder and plotting and witchhunts were very much part of the medical fabric of Scottish medical lunacy and so you hang on to Westminster and I will hang on to the scenery and if we float off, alone, then so be it….. just wish I could throw the Scottish medical establishment here over the side as we go……
Although I studied Shakespeare, I should have paid more attention when we were studying Brave New World……..
What has gone totally off the radar is that persons do not feel quenched unless the patient leaves their surgery with a prescription. The modern medicine propaganda machine has developed a thirst…..I want a pill….I want….I want….I want….
This is what Westminster has done………….
It all seemed so sci-fi then, not fashionably feasible to become inured to the danger you are putting yourself in swallowing anti=depressants, statins and benzos without a thought for your long term health.
Nobody else gives a tinkers’ arse, for your long term health……..except, YOU.
L’Wren Scott, did you take a pill?
How do we bear this?
The law of averages only takes one very high profile death to kick GSK into the middle of next week
http://huxley.net/
I’m Scottish, live in Scotland, and will likely be voting Yes because of the Westminster government. I’m fed up with the targeting of the poor and people with disabilities, the work capability assessments that cause people with mental health difficulties to become more anxious and stressed. The recovery movement hijacked by government doesn’t impress while psychiatry still labels and drugs, giving lifelong mental illness prognoses and disabling side effects, shortening lives by up to 25yrs.
I go to my Scottish GP only when I have to, which isn’t very often. I’m 61 and only on one drug, for blood pressure, candesartan, but I am dieting, losing weight, getting fit so as to come off the drug. I’ve just bought my own blood pressure monitor to keep a check on my own BP, each day. I’d been given a Dr Iona Heath article by a psychiatrist friend ‘GPs should ignore QOF targets for hypertension, says former RCGP president’:
http://www.pulsetoday.co.uk/clinical/therapy-areas/cardiovascular/gps-should-ignore-qof-targets-for-hypertension-says-former-rcgp-president/20003013.article#.UyiTwYX_0zI
I have no other health conditions and anyway I’m intolerant to pharma drugs of any sort so it makes sense to do my best to manage my health without having to swallow pills or potions. I was first put on lisinopril which gave me diahorrea although I thought it was IBS and the GP didn’t disagree. It was only when changing to candesartan that the diahorrea stopped within 48hrs. Very annoying to think I’d put up with it for a few years. Unnecessarily. More and more I’m of the opinion that I’m the expert of my own health.
I have a gallstone the size of a golf ball, according to a scan I got about 16yrs ago after a gallbladder attack. However I decided to keep the stone and have only had one other episode since then, due to stress which eventually subsided. The gallstone is a barometer for my health, telling me when I need to take things easier by an ache. I can eat what I like, fatty foots or whatever and it’s not affected. I prefer not to have invasive surgery if it can be helped.
I’m not keen on all these tests that I’m told I should, because I’m over 50, have to ward off cancer. I thought cancer cells were in our bodies anyway and just flared up due to stress and other factors. I really don’t like to be “fiddled with”. When I had the gallbladder flare up about 6yrs ago the GP gave me a different painkiller, not cocodamol. Well this new drug caused me to projectile vomit and I lost some sight in one eye, fortunately my “bad” eye. Then I got loads of tests at Ninewells Hospital, putting drops in my good eye which caused an infection. At the end of it all, MRI scans and who knows what else, they couldn’t find out anything wrong and agreed it was a burst blood vessel which I said it was in the first instance. All that fiddling did more harm than good.
I’ve got plenty more stories of medical treatment that aren’t positive. Eg getting maximum doses of venlafaxine in 2002/3 which didn’t lift my mood, gave me suicidal impulses (I took an overdose and had to watch out after this). Being put on lithium to “augment the anti-depressant”. Then in March 2005, after I had got off the psych drugs and recovered from mental ill health, when walking down a stair, I didn’t trip or fall, I fractured my right fibula in 3 places, requiring a six inch metal plate to be inserted. Recently I read research articles that mention bone loss with max doses of venlafaxine in older people. That explains my fracture. Fortunately I didn’t have osteoporosis and I am quite fit and agile, despite getting some pain and numbness. Although this could be due to the BP pill, who knows?
So there you have it. I’m no witch but I’ve got common sense together with a lifetime’s experience of my own body and mind. The best thing that a doctor can do for me is to listen carefully and to hear what I am saying. If I want their help then I’ll ask for it. I want to see a paradigm shift in psychiatric treatment so that there are alternative ways of working with people in distress. Not just drugs and coercion. I am every hopeful for positive change and for more independence. For all of us.
Five concurrent drugs seems like an excessive drug burden to me, unless they are all for extremely serious illnesses.
It sounds like doctors are now becoming Autistic. They don’t seem to be able to make medical judgements. Take the BMI – this is a standard, but the only way to tell if someone is over weight or not, is by looking at them, and how their body is made up.
So… what do figures mean, divorced as they are from consequences. There won’t be any ‘positive change’ in my lifetime. My doctor, who for some reason is generally respected, gets a +23 on this scoring. An abstraction which does not translate into the utter destruction, pain and chaos our family now endures as a consequence of her prescribing habits.
Govt. guidelines, and other heinous agendas, are turning brainwashed medics into new Nazi-style population controllers. It is time the whole malignant system is overthrown.
Dr. Healy,
Thank you for your post. I am seeking further clarification of your statement that the risk of harm probably outweighs the benefit of “statins for cholesterol elevation in the absence of other cardiovascular risk factors”.
My question is this: in your opinion, what “cardiovascular risk factors” would need to be present to warrant statin use among asymptomatic people who have elevated cholesterol but do not have established cardiovascular disease?
More generally, the question pertains to the use of statins for primary prevention. If I recall correctly, you do not advocate statins for this purpose, nor do I.
http://www.theguardian.com/society/2014/mar/21/-sp-doctors-fears-over-statins-may-cost-lives-says-top-medical-researcher
https://www.madinamerica.com/2014/03/40305/
Following in the footsteps of Professor David Healy, last year, Professor Peter Gotzsche is going to Westminster.
How many of us have been railroaded by psychiatry into taking highly toxic dangerous drugs with no thought for our safety as we are surrounded by nincompoops who push us into suicidal situations…..and then look all surprised with their complete denial….
If Westminster doesn’t wake up with a Gotzsche attack, then god help us……
In your uptime in Novia Scotia check out the McGarrigle sisters; in your downtime in Novia Scotia, knock ’em dead.
How history comes to haunt me in Novia Scotia.
What a bizarre twist of fate that my doctor called me in my caravan from Prince Edward Island to tell me ‘ he was a very busy man and did not have time to read my correspondence’ about his colleague, who he had left behind, lying about drugs in crystal clear, black and white.’
The drug he told me about before he left ‘I did notice you were not given Fluoxetine’.
When you get a telephone call from Prince Edward Island from a man in high anxiety, his time 7.00am, with a ‘how *are* you, Annie, and, I, say, have you any idea what happened to me and the silence goes on for such a long time between us, that one of us has to say something………I said, thank you, for calling, Robbie, and put the phone down.
Don’t you just want to curl and up and die when a doctor does this?
Or, not. Don’t you just want to send in a report to the Medical Health Council, Fraud Department, and mention words such as gross intimidation, aiding and abetting, covering up a murderous act by a colleague, and other such worthy thoughts.
And, will little old MHC believe me over ‘my doctor’, will they hell……..He was a very busy man and did not have time to discuss the little matter of his colleague lying about giving me Fluoxetine, which she did not, over the course of an 8 week Paroxetine withdrawal which led to an extremely violent episode.
An instruction the psychiatrist put in a letter. And, when I am in his hospital, right in front of him, after a seismic seroxat withdrawal, what does he do?
He does not check on my medication.
For goodness, sake……………………
I know when I have been stitched up, but I also know that I went to a McGarrigle Sisters concert at the Concert Hall in Glasgow, so, Novia Scotia, is somewhere, I would love to visit for the Cape Breton music.
Hope you get to enjoy the scenery, Professor, as well, as giving it all you have got.
With thoughts for a good trip.
Definitely make a written complaint, and include the time and content of the phone conversation.
Thanks, Altostrata. The huge time I had getting a lawyer about all this and then receiving such an appalling 50 page missive explaining what a terrible person I was, knocked my confidence, somewhat.
You were the one who told me NICE recommend Fluoxetine and that totally opened up my eyes to this appalling situation. Thank you for caring.
I am a brilliant record keeper. I have every single email, every single letter, every detail of telephone calls, every report from two hospitals and so on.
I have my case.
I was going to post this on Richard Lawhern’s post over on Rxisk.org, but have decided to put this here, instead.
What do you do when your doctor doesn’t, especially, like you.
I know I keep banging on about Paroxetine, but, two weeks after my ridiculous lady doctor came storming into my bedroom telling me to pull myself together when I was hyperventilating and confused and terrified, I retreated back under the duvet.
She had dropped me off Seroxat, abruptly. She had not taken the advice of the psychiatrist to give me Fluoxetine. She was aggressive.
Richard, your overview of internet research is good.
However, what do you do when you take in loads of stuff you have found on the internet regarding Paroxetine and the response is oh, no, not another one coming in looking up drugs, on the internet, on Google, and turning yourself into a hypochondriac. You have to listen to me, I am the professional.
What do you do, Richard?
I was so unfortunate to meet such a vitriolic gp in Scotland, who had so many issues of her own, that she put all her own inadequacies onto me.
This was what the psychiatrist did as well. He did not tell me that he had written to my surgery with advice about withdrawing from Paroxetine. He put his own inadequacies onto me, as well.
These two people a mere half an hour away from each other, have this secret about Fluoxetine and in four years cannot be bothered to tell me about it. I have posted my incredulity on DH blog about this.
However, I was straight on to the internet twelve years ago about Paroxetine. The support was fantastic. All the blogs sprung up fast and furious about Paroxetine and me, alone, abandoned and feeling like Attila the Hun, had a slight release. Off course, litigation started up. It always does.
We all have huge admiration for all bloggists, but, what do you do when doctor’s get personal.
When they start making remarks like ‘you don’t look your age’ or ‘no more men’ or you are a ‘total embarrassment to your family’, what do you do?
It was pretty weird when I was invited to spend a week with my doctor in her lovely house on the Isle of Bute. It was pretty weird when she was watching me sip my Paroxetine liquid and she never, ever, once, mentioned that she should have given me Fluoxetine. And, when I dropped the liquid too soon and she rushes into my bedroom fourteen months later, with Fluoxetine, then I knew then that I was dealing with a seriously deranged, criminal, individual who had no right to be in my house.
And, as I said, to David, I got this telephone call from her boss, who totally understood the situation and realised what had happened and decided to become a criminal as well with bullying behaviour.
So, yeh, we can all go on the internet and find our problem, but, it could prove an irritable source of exasperation to some and some can totally destroy your life……………………
My situation is exceptional and thank you for continuing your input, Richard.
I could start my own Save us from Paroxetine blog, but, I would rather just comment occasionally with what doctors get up to, when they realise they have just nearly murdered their patient.
And, Sir Andrew Witty still denies all charges against GlaxoSmithKline who still deliver Seroxat and this may, at some point, cause him some concern about his neglect at facing up to Seroxat causing homicidal behaviour.
If I send in my reports to NHS Scotland, and the MHC, I am literally quite terrified that a huge inquiry might develop that will include my former partner, the pilot, my daughter, getting on with her life in BC, Canada.
Is it worth it, is the million dollar question?
To be honest, Altostrata, if I do not have the backing of the MHRA or anyone else, then, if I do what I know is right, it could completely backfire and I could become worse off than if I had not bothered.
If a legal gp, read through my entire medical records and came to the conclusion my gp did nothing wrong, how do I get the confidence to tell anybody how Paroxetine almost led to my demise.
I really cannot do this on my own.
All, I can do, at present, is wait until litigation perhaps begins, then I have it.
I cannot put myself through an almighty inquiry and come up wanting, again.
But, thanks.
I am not intending to let it go.
When people feel their doctors are talking down to them, I suggest they look the doctor directly in the eyes and say in a strong, calm voice: “I would prefer a relationship of mutual respect.”
The doctor will get the message.
Never beseech, whine, cry, or whimper in the presence of such a doctor. Do not lose your temper. Many doctors react poorly to emotional displays. Always speak calmly, clearly, firmly, and deliberately. Repeat yourself if necessary, as if training a large dog.
I did that.
When, dear, Rosemary, my friend, the doctor, said to me ‘no more men’, I retorted but you have one.
She said, but, he is just a part of the furniture. Her live in bloke was an alcoholic, and Rosemary, my doctor, who had an alcoholic father, and, brother, and, live in partner, in her house on the Isle of Bute had decided that my airline pilot was responsible for death from Paroxetine.
I walked Rosemary’s dogs. In fact, her dog bit me and drew blood and Rosemary did not apologise. She looked at me and if to say, this blood is your fault…….
Rosemary, did not react when I told her my dog had died.
Rosemary, did not react when I told her I had almost hung myself from the rafters of my garage from Paroxetine withdrawal.
Rosemary, wrote lies in my medical records.
Rosemary, told me, I would go deaf from the chronic tinnitus I now have, from abrupt Paroxetine withdrawal.
Rosemary, was sharp as a whip. That was why I was inveigled into her life.
If anyone wants a short, sharp, introduction to Stockholm Syndrome, this is it…..
I am not stupid, Altostrata, I was always cool Joe.
I know a deliberate act of sabotage when I see it……………….
Paroxetine led to emotional displays with me in front of this woman every day for six weeks. The medical receptionist said ‘it must be awful for your mother to watch you fall apart.’
Yeh, right.
Love the dog approach, but I was not emotionally equipped for Paroxetine cessation, howling like a dog, and, looking back, I never lost it in front of Rosemary until I begged, like a dog, to send me to a hospital……
http://truthman30.wordpress.com/2014/04/02/gsks-andrew-witty-recieves-fda-warning-letter-about-contaminated-seroxat-at-cork-plant/
We swallowed this muck and it seems Seroxat just won’t go away………tap tap tap drip drip drip