Better diagnoses or more misdiagnoses? What do rising prescription rates really tell us? | Fieldfisher
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Better diagnoses or more misdiagnoses? What do rising prescription rates really tell us?

With the average life expectancy in the UK now at around 80, it’s no surprise that prescriptions are on the rise. In fact, in the latest figures stated on the BBC news website an extra 34.5 million drugs and other prescription items were given out in 2014, compared to the year before.

In the report, carried out by The Health and Social Care Information Centre, it was revealed that prescriptions for anti-depressant medication rose by 7.2% – from 53.3 million to 57.1 million – and that treatments for high cholesterol and diabetes also went up.

No doubt this is in part due to an ageing population. It is also probably the result of better care and diagnoses. However, whatever the reason, the results demonstrate an increase in the number of people living with long-term conditions such as diabetes. The number of people diagnosed with diabetes is expected to reach 4.2 million by 2025 and the financial implications of this for the NHS are serious.

In an interview with the chief executive of Diabetes UK, Barbara Young went so far as to state there was a real possibility that diabetes could bankrupt the NHS within a generation. So what’s the solution?

Young believes public education is critical. An awareness campaign on the causes of Type 2 diabetes, she believes, would be a start. That and significant improvements when it comes to recognising those at high risk, so they can be given the support they need to stop the condition developing in the first place.

People with Type 1 diabetes require daily insulin injections but those with Type 2 diabetes – although they may require certain oral drugs and, in some cases, insulin – may be able to manage their condition with lifestyle changes. Should the focus not, therefore, be on education and preventative measures rather than drugs?

With mental health issues the case is more complicated still. The mental health charity Mind says more needs to be done to understand the rise in antidepressant prescriptions. Paul Farmer, chief executive of Mind said that whilst anti-depressants can be very effective for some, they were not necessarily the solution for everyone.

For me, the trend towards more preventative medicine can only be a good thing. A frequently debated topic in the press is whether anti-depressants are prescribed too readily and there is definitely a case for more caution when it comes to long-term anti-depressant prescriptions. But it’s a topic that causes much divide.

In an opinion piece in the British Medical Journal back in 2013, a practicing doctor in Glasgow sparked debate when he suggested that as few as 1 in 7 people actually benefits from anti-depressants and that the criteria for assessing whether someone is depressed or not were unrealistic. For example, he said that according to the handbook frequently used by psychiatrists, The Diagnostic and Statistical Manual of Mental Disorders, being low for two weeks after bereavement should be considered depression.

This can lead to the misdiagnoses of many elderly people – a claim backed up by a recent study carried by Dr Eiko Fried and other researchers at the University of Leuven in Belgium. When questioning elderly volunteers about their mental health, they found that those in mourning suffered mainly from loneliness. The study, published in the Journal of Abnormal Psychology, suggested that the loneliness experienced could be so overwhelming that it could be interpreted as depression, despite those questioned displaying few other symptoms.

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This topic is clearly a highly contentious one. But the fact remains that misdiagnosis and over-prescribing does happen and, when it does, the implications for the patient can be life altering. With prescriptions of all kinds on the rise, surely it makes sense to look at all the options for treatment, prevention and education – as one size definitely does not fit all.