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hose in their 70s and beyond are
by far the major beneficiaries of
modern medicines that vanquish
(or mitigate) the physical trials and
tribulations of later life – arthritic
joints, impaired mobility, heart failure,
and much else besides. Many troubled
by more than one such ailment will
need to take a combination of
medicines, so called “polypharmacy”
(literally “many drugs”).
But caution is necessary. The late
professor D R Laurence in his classic
textbook Clinical Pharmacolog y- required reading by medical students
for many years – summarises the eight
separate reasons for the increased
tendency for drugs to cause harm in
later life, concluding unassailably:
“Drug therapy in the elderly should be
kept to a minimum.”
In recent years, this cardinal
principle of sensible prescribing has
been reversed with serious
consequences reiterated yet again in
yesterday’s report from Age UK with its
self explanatory title “More Harm Than
Good”. The relevant statistics could
reasonably be described as awesome.
In just 15 years, the number of
prescriptions issued by family doctors
has increased threefold – an additional
600 million each year. Four times as
many take at least five drugs, three
times as many take 10 or more.
And the consequences? The most
readily quantifiable evidence of “more
harm than good” cited by the report
has been the massive upswing in the
numbers requiring hospital admission
for a medical emergency caused by the
drugs they are taking: from 60,000 10
years ago to 90,000 in 2015. Most
commonly, the patient will have
sustained a fall-related fracture or head
injury due to dizziness or balance
problems. But many other types of
medical emergency may also be
drug-related – coma, delirium,
dehydration, internal bleeding and so
on. Alongside these additional 30,
hospital admissions there will be many
more for whom drug side effects,though less serious, may none the less
grievously compromise their quality of
life. Thousands of readers of my
weekly medical column have written
to tell of the misery of their muscular
aches and pains, fatigue, insomnia, gut
disturbances and general decrepitude- and their seemingly miraculous
recovery on reducing the dosage or
stopping their medicines.
There is no novelty in any of this.
Doctors recognise the problem, with
nine out of 10 GPs in a straw poll
admitting they prescribe “too many
pills”. There is scarcely an issue of a
medical journal nowadays that does
not feature an article touching on some
aspect of polypharmacy. But the
phenomenon of over-medicalisation
continues. The Age UK report
attributes this to doctors “not having
the time or information they need” and
so they “overestimate the benefit of a
treatment while also underestimating
its harm”. This fails to confront the
fundamental issue that polypharmacy
is now deeply entrenched in routine
medical practice. And it will remain so
without an acknowledgement by the
medical profession of its culpability in
bringing it about.
To be sure, the pharmaceutical
industry has deployed its immense
wealth and influence to promote, by
Britain’s over-prescription
problem is nothing new.
When will ministers
finally step in to stop it?james le fanuanu
I
t’s easy to sympathise with
Emmanuel Macron. Britain is
leaving the EU club but wants
to keep the benefits of
membership (free trade)
without agreeing to the
obligations (the diktats). If we get
away with it, where would that leave
Europe? He once admitted that even
France would “probably” have voted
to leave the EU if given the chance:
Marine Le Pen, his great antagonist,
has talked about giving people that
choice. Understandably, Mr Macron
needs to put people off this idea. So
he must show that the EU does not
bend when threatened and that
countries who break away face
isolation and political ruin.
Angela Merkel is more pragmatic.
The Germans worry not just about
the disruption, but about losing
Britain to America’s diplomatic orbit- hence her suggestion that she is
open to a better Brexit deal. Why lose
jobs, or trade, if there is an
alternative? But she also understands
that the EU is in a bind, that its
reputation and perhaps its survival is
at stake.
It has said it won’t renegotiate. If it
caves in now, that’s an invitation for
more pressure. With politicians like
Matteo Salvini at large in Italy, itching
to tear up the EU rulebook, we see the
problem. The economics might say:
cut a deal. But the politics says: don’t
back down. In Brussels, politics
usually wins.
Boris Johnson’s trips to Berlin and
Paris this week have highlighted this
tension, and there’s not much time for
resolution. The expectation in
Whitehall and beyond is that neither
the Prime Minister nor the EU will
buckle, so we will end up with a
no-deal Brexit. But then comes the
trick: it would not really be a no-deal
Brexit because there would be dozens
of mini-deals to break the fall and
minimise disruption. Done properly,
these mini-deals could reconcile the
political and the economic. No one
loses face. No one takes too much of a
financial hit.
If this sounds fanciful, look at what
has happened already. Michel Barnier
might have noisily ruled out mini-
deals, but that didn’t seem to stop the
European Commission churning out
lots of little Brexit parachutes. At the
last count, there were 100
“preparedness notices” published and
109 contingency measures approved,
with 46 no-deal laws proposed or
adopted. So UK citizens will not need
short-stay visas. Deals are now in
place to keep aircraft flying, no matter
what, and cars and lorries on the road.
EU cash will keep flowing to UK
projects, British students on EU study
grants can finish their courses. The
list goes on.
Meanwhile, governments across
Europe have been agreeing similar
packages, mainly protecting the
status of UK nationals in the event of
no deal. In January, the French
parliament gave itself powers to
protect British expats, to help ensure
finance continued to flow and thatcustom controls were smooth. The
same month, Spain has published a
royal decree making similar promises.
And for his part, Boris Johnson has
promised all EU nationals that they
can stay, without condition.
Brexit mini-deals aren’t terribly
difficult to sign because they just
protect what already happens. And if
the EU decides to meddle, and get in
the way? The French parliament has
passed laws allowing it to strike deals
directly with the House of Commons,
in certain areas. The no-deal process
need only cause as much pain,
disruption and friction as the EU
seeks to create. And if the great Boris
Johnson ends up humiliated, his
hopes for a deal dashed, his “million-
to-one” chance of no-deal shown to
come true, why make things worse
than they need to be?
This all comes at a delicate time for
the European economy – especially
for Germany, now bracing itself for a
severe slump. A no-deal Brexit would
inflict a high price. A study for the
Belgian government a few weeks ago
put some figures on it: 139,000 jobs
lost in Italy, 141,000 in France,
291,000 in Germany. The French
finance ministry has added a price
tag: an €11 billion hit for Italy,
€14 billion for France and €30 billion
for Germany.
To volunteer for pain of this sort
would be a kind of madness. Many in
Europe think Brits are already mad
for voting for Brexit in the first place.
Fair enough, and it’s a view shared by
many Brits, but the damage need only
be as bad as politicians want to make
it. Given how worried Germany is
about its car industry, is this really the
time to erect a needless 10 per cent
tariff on sales to Britain, the world’s
biggest importer of German cars?
Mini-deals, keeping things as theyEuropean officials are
working hard behind the
scenes to produce a series
of contingency mini-dealsfraser nelsonlson
Belinda Parmar
Too many pills do more harm than good
Social media
firms should
force their users
to show ID
T
he Manchester United
dressing room isn’t
where one would
normally look for public
policy ideas – but perhaps
that ought to change. Step
forward the team’s centre
back, Harry Maguire, whose
intervention has been
hailed by MPs. He believes
the big social media firms
should be made to ensure
that everybody on their
platforms has had their
identity verified. This, he
says, would cut down on
online trolling, including
the racist abuse handed out
to his teammate Paul Pogba
following their draw on
Monday night against
Wolverhampton Wanderers.
With the rise of modern
camera technology, people
who shout racist abuse at
football matches, even
though they may be in a
crowd of tens of thousands,
are often identified and
punished. The same cannot
be said of those who do the
same on social
media. This clearly isn’t
good enough – and
anonymity online is a big
part of the problem.
The use of unverified
accounts allows trolls to
post whatever they want
without having to take
responsibility for it,
severing the connection
between a person’s actions
and their consequences.
I genuinely don’t believe we
would have anywhere near
as many racist, sexist,
anti-Semitic and otherwise
thoroughly unpleasant trolls
if they knew that their
parents, colleagues and
friends could see what they
were saying.
It is especially important
to hold people accountable
online because the whole
system is set up to eliminate
empathy. Racist thugs in a
stand at a football ground at
least have to look at a player
when they abuse him, they
can see his shoulders drop
or the hurt in his eyes.
Online trolls won’t see even
that and it is all too easy to
for them to become
emotionally detached from
the harm they are causing.
The best way to resolve this
devious means, that threefold rise in
the number of prescriptions. Who
would know that the benefits of
commonly prescribed drugs as
reported in industry-sponsored clinical
trials are systematically exaggerated
fiftyfold or that in certain instances 98
per cent of those taking them may gain
no advantage from doing so?
But the major obstacle in rolling back
the tidal wave of over-prescribing is the
Faustian deal made between family
doctors and the government in 2004
that decided they would be “paid for
performance”, their income dependent
on maximising the number of patients
diagnosed and treated for a given set of
conditions. According to this formula
most of the elderly now automatically
qualify to be treated with, for example,
the antihypertensives, cholesterol-
lowering statins or antidiabetic drugs- all of which are heavily implicated in
causing those 90,000 emergency
hospital admissions. The Age UK report
has served a useful purpose in drawing
renewed attention to the propensity for
drugs to cause harm but it will be to
little avail without the political will to
take the necessary steps to reverse this
medical catastrophe.
James Le Fanu is the author of ‘Too
Many Pills’ (Little, Brown)The EU cannot afford a no-deal.
Luckily, it has a parachute handy
are for nine months at least, would
avoid the pain. And they are being
struck at a faster rate than anyone
likes to admit.
The EU is still placing its hopes on
Dominic Grieve raising a rebel army
that could depose the Tories and see
Brexit shelved. Or it hopes Boris
might panic and end up pushing
Theresa May’s deal through the
Commons complete with the
backstop – albeit with a tweak,
perhaps a time limit. At this stage,
Leo Varadkar (who is facing awkward
questions in Dublin over his lack of
no-deal preparations) might find the
offer of a time-limited backstop
irresistible. Perhaps the EU itself will
cave. But none of these things are
likely.
Pretty much everyone thinks the
most likely scenario now is that
Britain leaves on October 31 without
anything resembling Mrs May’s
599-page Withdrawal Agreement. But
rather than this being the giant
cliff-edge cataclysm that Treasury
forecasters like to imagine, it would
be a no-deal Brexit with lots of small
parachutes. And there can be larger
ones: Britain might promise not to
sign any trade deals for a couple of
years, for example, and stick to EU
regulations. This should help keep
trade as it is, at least for now.
So a no-deal Brexit just won’t
happen. The alternative to a deal is a
world of mini-deals, many of which
have already been agreed, many more
which can be agreed upon fairly
quickly. Will they be enough to stop
the damage – or, at least, avoid the
worst of it?
That’s a whole different discussion.
But with the main talks going
nowhere, it’s a discussion that all
sides now have a pretty strong
incentive to complete.To order prints or signed copies of any Telegraph cartoon, go to telegraph.co.uk/prints-cartoons or call 0191 603 0178 [email protected]fundamental flaw is to do all
we can to ensure that the
concepts of stigma and
shame which help to define
acceptable behaviour in the
real world extend to the
online realm, too.
Introducing identity
verification doesn’t have to
be complicated, as the use
of existing age-verification
software shows. There are
lots of companies working
in this space, from Yoti Age
Scan, which uses facial
recognition technology to
estimate age, to Pass, the
government-backed
proof-of-age scheme
launched in 2000 to combat
the use of fake IDs. If they
can do it for age, they can do
it for identity, too. AirBnB,
for example, already has a
system whereby users can
be asked to scan some form
of ID before letting or
renting a property.
The stumbling block here
is that social media
companies simply don’t
want to do anything about
the sewers that their
platforms have become. But
if they don’t care, it’s up to
us to make them care. We
need people like Harry
Maguire and other role
models to speak out, to
expose the dreadful
treatment people in the
public eye receive at the
hands of anonymous trolls
and to call on social media
companies to institute the
rules required to solve this
problem.
Time was when racist
abuse was par for the course
on football terraces. Now
clubs take a zero-tolerance
approach towards the
perpetrators and work hard
to stamp it out. There is no
reason social media
companies shouldn’t be
held to the same standard.Belinda Parmar is CEO of
The Empathy Business, and
founder of The Truth About
Tech campaignfollow Fraser
Nelson on Twitter
@FraserNelson;
read more at
telegraph.co.uk/
opinionread more at
telegraph.co.uk/
opinionfollow Belinda Parmar on
Twitter @belindaparmar;
read more at
telegraph.co.uk/opinionComment
18 ***^ Friday 23 August 2019 The Daily Telegraph
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