There are many RxISK posts on antibiotics – look under antibiotics – with 6 or so dealing with Fluoroquinolones from the original Flox-Tox to Fluoroquinolones: Not so Carte Blanche. Miriam Knight has written this one.
Doctor: “I’ll give you an antibiotic to clear that up”.
Me: “Thanks very much”.
I imagine just about everyone reading this will have had that conversation. I know I’ve been very pleased to have an antibiotic for various things over the years, including chronic cystitis in the early 70sd. My older sister, a chemistry graduate no less, told me the reason I got thrush straight after cystitis was because the antibiotic killed off all the good bacteria ‘down below’ allowing the thrush to get a grip. So, next time it happened, I blithely asked the doctor if there was an antibiotic that wouldn’t cause thrush, fully expecting him to say ‘gosh, thanks, I didn’t realise…’
His actual reaction was one of near anger – what nonsense, he’s never heard of that and no, that doesn’t happen. As predicted, I was back in the surgery a few days later with more thrush but didn’t dare to say ‘I told you’.
Since that time I’ve always been amazed at the attitude of the doctors I’ve met who have an unshakeable faith that what they know is right and what they don’t know doesn’t exist. I didn’t know it then but ‘built-in doctor-denial’ dominates my waking hours as I, now 68, struggle to raise awareness about the dangers of certain antibiotics. My sister’s advice has been replaced by Dr Google and I can access guidelines and academic papers just as easily as any doctor yet I’m repeatedly told not to believe everything I read on the Internet.
I used the word “dangers” above, which isn’t generally associated with the antibiotics that we’ve come to rely on to ‘clear things up’, although everyone is aware that some people are allergic to penicillin.
The struggle I mentioned began in 2013 when my husband was plagued with urinary tract infections (UTIs) caused by his indwelling catheter – caused, in turn, by his MS. He was always given an antibiotic, and, if that didn’t work, a stronger antibiotic. Twice the doctor resorted to an even stronger one which he called a third line of defence and which always did the job. (Notice I’m not using any names here because, back then, the names of the various antibiotics didn’t seem important.)
Cipro
My husband was more or less bedridden at this time from both the MS and a recent bout of sepsis caused by a UTI that I hadn’t spotted. After that I watched like a hawk but yet another UTI came along leading to treatment with Trimethoprim followed by Cephalexin (learning the names now). Then the strongest antibiotic – which I remembered because the packet said not to take dairy products with it (more Coffeemate in his tea!). Three days later Phil was lying in agony and the name Ciprofloxacin and its huge list of side effects were firmly embedded in my mind.
When he said he couldn’t move because of the pain my first thought was that he’d had some kind of stroke. I offered him his next Cipro tablet but he refused it saying they were causing the pain. I secretly thought that was nonsense but took out the packet leaflet to see what side effects were listed. He was on several permanent meds so I didn’t usually pay much attention to the leaflets but reading this one was a genuine OMG moment. Possible aches and pains galore listed and even the chance of Achilles tendon rupture, which I thought seemed quite random at the time.
When I added ‘problems with’ to my ciprofloxacin search and discovered a whole new world of long-lasting disabling pain and debilitation with many other serious things thrown in. I discovered it can happen immediately or after several courses (as with Phil), and that it’s often described as a time bomb waiting to go off as it can even start months after a course has been finished. It can have serious psychiatric side effects as well as physical and that some people were still not recovered after several years. OMG again – how to tell a man who’s already bedridden that things may get very much worse?
I learned that ciprofloxacin is one of a class of synthetic antibiotics called the fluoroquinolones and has siblings called levofloxacin, moxifloxacin, norfloxacin and ofloxacin (also called Cipro, Levaquin, Avelox and Floxin in the US plus there are many other names and generics). I found that they were preceded by the quinolones (in the 70s) and then a fluorine molecule was added to improve tissue penetration leading to the first fluoroquinolone, Cipro, being launched in 1987.
Approval was rushed through by the FDA as a treatment for anthrax and it was handed out (secretly) to servicemen in the first Gulf War (perhaps contributing to the Syndrome?) and was also given to the Washington Postal Workers when an anthrax threat was feared in the 90s (resulting in a court case). Despite rumours about the possible severe side effects, fluoroquinolones became very popular as THE most reliable antibiotics up until 2012 when fears about resistance started to slow their use. I read a quote by one US doctor that will always stay with me – he said using Cipro for a minor infection is like using a Kalashnikov to kill a mosquito.
Most worrying was reading in a 1996 paper that ciprofloxacin was found to damage mammalian mitochondrial DNA. I vaguely remembered something about mitochondria from my school biology but couldn’t imagine why an antibiotic would have any effect on them. Then I read that Cipro had also been used as a chemotherapy drug. This was sounding unreal so I stopped reading.
In the morning our doctor told me they’d never come across any problems with it, that he’d used it correctly (as third line defence) and that there were stories about it but I shouldn’t believe them. He couldn’t offer any explanation as to why Phil was in such pain but said luckily the infection results came back negative so it didn’t matter that Phil had stopped taking them. So why was he given them? ‘Just in case’! He said he didn’t know anything about mitochondria so I suggested he looked it up. I don’t know whether he did because he won’t discuss it with me even now.
Forgetting Doctors
I soon realised it’s no good trying to talk to doctors who, I believe, are trained not to question the drugs they are told to prescribe and to not listen to patients who have read something or seen it on the telly. I decided to take my questions to the top and started writing to the people who licence the drugs, the MHRA. I also co-founded a Facebook Group with a “floxie” (someone affected by one of the -floxacins), to try to find others in the UK who have been harmed by fluoroquinolones. Our aims are to offer support and provide information as well as to try to raise awareness. I am always saddened when someone asks to join us saying that their doctor doesn’t believe the fluoroquinolone can have harmed them and that their friends and family believe the doctor. We’re often told we’re the first people who actually understand what’s happening to them – which is shocking given that there’s so much information out there about it.
In 2021, doctors are still as big-headed and unwilling to learn something new as they were in the 70s. They adapt and progress but are not allowed to think outside the box and they get vilified if they dare to question the norm. I know of three floxed GPs who have had great difficulty in getting any of their colleagues to acknowledge that a fluoroquinolone had caused them so many ongoing problems that they had to retire. One of them was persuaded that her painful symptoms were psychological and was sent on a two year journey of seeing various mental health specialists and was offered a variety of drugs to help with the ‘perceived pain’ – which is kind of why I’m writing this blog.
Gaslighting, or getting rid of troublesome patients by sending them down the psyche route, is convenient but very dangerous. Many drugs usually prescribed for physical problems, especially antibiotics, hormone treatments and anaesthetics, can have serious psychological effects although this is rarely recognised. When used alongside antidepressants or antipsychotics, they can all be dangerous but the fluoroquinolones do deserve a special mention because of the way they act upon the GABA receptors (“some of the most common neurons in the mammalian nervous system”) .
GABA has important effects on the brain’s normal function. Too much and you will be physically slower, have lower energy, be relaxed or sleepy. Too little and you will struggle with anxiety, panic attacks, or even seizures.
The fluoroquinolones bind to the GABA receptors, effectively acting like an emergency brake, leaving anyone liable to suffer insomnia and depression or anxiety attacks. A patient who is already taking prescribed drugs active on GABA will find themselves suddenly cut off from their medication’s effects even if they increase the dose. Psychosis and convulsions have been recorded although I have to say that the worst case I know of is somebody who had already been suffering from akathisia for 2 years (caused by a new doctor “tweaking” his long term meds) when he was given ciprofloxacin in A&E “just in case”.
This person carried a card from the Akathisia Alliance stating that he suffered from akathisia and must not be given various drugs, including the fluoroquinolone family, which might exacerbate it. He had to go to hospital with a severe pelvic pain and, despite blood and urine tests being negative, and despite showing his card, he was given Cipro. Cipro is only supposed to be used as a third line defence, i.e. when two other types of antibiotic fail, yet this A&E doctor ignored not only the card but also the guideline. A frightening demonstration of not only how little some of our doctors know about combinations of certain drugs but also how little they care.
This guy’s akathisia suddenly became stronger because the Cipro ‘turned off’ the 15mg of diazepam he’d been on for two years (to help overcome it). But then he was also beginning to experience many other adverse reactions that fluoroquinolones can cause, including severe pain in the muscles and joints. His gut was also severely affected and he started to get strange temperature problems including ice cold soles of his feet yet burning fever and sweats. What do his doctors say? Nothing! Apparently he has a long history of being obsessed with his health (hence the long term meds) and this is nothing at all to do with the Cipro. I’ve sent his Clinical Team documents such as the EMA report referenced above along with information from the Cipro Patient Information Leaflet (5) and the doctors guidelines (SmPC), all of which list the adverse reactions including those that he’s experiencing. But no, it’s nothing at all to do with the Cipro – it’s definitely all in his head.
In my support group we find most people suffer mainly from very painful physical effects with any depression, insomnia and panic attacks as some kind of supporting acts. The EMA Report details how the fluoroquinolones cause such mayhem in the body and cites its main effect is to disrupt our mitochondria and the whole process by which we convert nutrition into energy (the ATP cycle). Each one of our cells (apart from red blood cells) contains anywhere between 100 and 5000 mitochondria depending on its particular job – for example one heart muscle cell might have 5000, a liver cell has around 2000 and a ‘normal’ cell just 100 or so. This ‘mayhem’ leads to oxidative stress which disrupts our cells.
The result is mainly pain; pain in the muscles and tendons (the Achilles and other tendons can rupture), pain throughout the nervous system with peripheral neuropathy being a huge problem, and burning pain or pins and needles in the skin. Add to this gut problems, eye and ear problems, dizzyness, fatigue plus the insomnia etc. mentioned above and you begin to get the overall idea that fluoroquinolone antibiotics are not very handy. The full list of side effects, warnings and cautions are in the packet leaflet, although this doesn’t mean that a doctor will actually think any experienced problems listed are to do with the drug he’s just prescribed!
Very few people are affected immediately. Some only feel something is wrong after a couple of courses while others say they’ve taken many courses without any problem at all. Who is affected, how seriously and by how many tablets seems to depend on the mitochondrial health of each individual. Various factors to do with any genetic deficiencies from birth, exposure to environmental and/or pharmaceutical toxins, lifestyle (eating, drinking and fitness habits) and age all play a huge part. Simply put, we all need a certain amount of energy to get through a day and a healthy young adult probably has 60% more mitochondria than they need. This spare capacity drops as the mitochondria get ‘insulted’ over the years by bad diet, living next to a busy road or factory (environmental toxins), taking long term pharmaceuticals (also toxins) while a genetic defect at birth might start to manifest itself in young adulthood as maybe MS, Ehlers-Danlos, Rheumatoid Arthritis etc. We naturally expect to slow down as we get older but we don’t really expect an antibiotic to bring us to a grinding halt!
Stephen Fried’s book Bitter Pills outlining many of these problems was published in 1998. It took two decades for FDA in the United States to recognise Fluoroquinolone Associated Disability (FAD) Syndrome in 2016.
Doctors should be aware of the dangers but few of them are. Don’t just accept “an antibiotic”. Question it if you or anyone you know is prescribed a fluoroquinolone.
Miriam Knight
co-founder Quinolone Toxicity Support UK
susanne says
Dentists as well as doctors don’t understand the concept of ‘rare’ either. I had serious adverse effects to flagel after being prescribed them for an
ulcer. Years later I needed an antibiotic again for the same problem , told the dentist I couldn’t use flagel and was treated like an idiot . ‘You couldn’t have had adverse effects because they are very very rare’. I explained the meaning of rare means the effects do occur and she prescribed a different one. So often they see information given in good faith ,not to make them look incompetent, as a challenge rather than a useful addition to their knowledge! The adverse effects are listed on google.
annie says
Fluoroquinolone Side Effects Just Got Scarier
https://journals.lww.com/em-news/fulltext/2018/10000/infocus__fluoroquinolone_side_effects_just_got.12.aspx
Miriam – and ‘Forgetting Doctors’ …
Overprescribing of medicines must stop, says government
“GPs will only ever prescribe medication to patients in conversation with them,and after a frank discussion about the risks and benefits of the treatment – and when alternative options have been explored.
https://www.bbc.co.uk/news/health-58639253
Government pledges to reduce overprescribing of medicines
https://www.gov.uk/government/news/government-pledges-to-reduce-overprescribing-of-medicines
As is often the case,
Simon Wessely Retweeted
The BMA
@TheBMA
The narrative that GPs are refusing to see patients face-to-face is dangerous and inaccurate and it has to stop. We call on the health secretary to speak up openly and unequivocally in support of general practice, and have written to him outlining three specific action points.
https://twitter.com/TheBMA
Fury as UK’s top doctor says patients will ‘GET USED’ to not seeing their GP face-to-face – as he admits many now only work three days a week
https://www.dailymail.co.uk/news/article-10016079/Get-used-UKs-GP-says-face-face-appointments-WONT-pre-pandemic-levels.html
“Dr Chaand Nagpaul, chair of the BMA council, can rant all he likes about Covid safety measures and ‘an onslaught of abuse and media scapegoating of GPs and their staff’. The fact remains: patients are suffering, even dying, and it is his job — and duty — to do something about it.”
“The fact Dr Nagpaul is so defensive is, in many ways, the root of the problem. There seems to be a fundamental refusal to accept the existence of a problem, let alone that he and his members should in any way be held accountable.”
“Instead of excuses, he should offer solutions. Instead of bleating about workload, he should find out why, if GPs are, as he claims, ‘seeing more patients than ever, working longer hours than ever’ it does not seem to be translating into adequate care.”
mary H says
David, for a long time now, you have warned that, since prescribed drugs work so well (according to them), doctors will not be needed since nurses or pharmacists could do their job for far less money. It seems to me that here in the UK doctors are now busy pushing themselves out of the picture! If they are not there for patients then what exactly is the point of their being there at all?
Miriam Knght says
Hi Annie, thanks very much for your informative reply. I’d missed the ‘FQ side effects just got scarier’ article from 2018 (as did the majority of US doctors, I imagine!) and have come away with one very important quote from it:
” it’s a mystery …”
HCPs seem to be totally unable to grasp the fact that so many different problems can come from ‘just an’ antibiotic – yet the explanation is there in the article – fluoroquinolones are unique in their bactericidal action. Our mitochondria are very close relatives of bacteria which says it all.
Thanks for the covid/GP info too – one argument at a time…
susanne says
They need to do a breakdown and publish it ,of which medicines are most over prescribed surely. And what the consequences actually were in detail, on those prescribed to were.
This site is intended for health professionals only
Government to ‘take action’ after finding 10% of medicines ‘overprescribed’
Government to ‘take action’ after finding 10% of medicines ‘overprescribed’
overprescribing
Sofia Lind
22 September 202
Ministers have pledged to ‘take action’ on overprescribing after an official review concluded that 10% of medicines dispensed in primary care in England were not needed.
The Department of Health and Social Care (DHSC) said this would include GP practice training and moves to alternative treatment options including social prescribing.
It will also mean ‘ensuring GPs have the data and medical records they need’ and ‘are empowered to challenge and change prescribing made in hospitals‘, it added.
This comes as a Government-commissioned report, published today, said that 15% of people are now taking five or more medicines a day, with one in five hospital admissions among over-65s caused by adverse effects of medicines.
Ministers have ‘accepted all recommendations’ from the review, which was led by Chief Pharmaceutical Officer for England Dr Keith Ridge.
The review was commissioned in 2018, after NHS figures showed a 5% year-on-year growth in spending on medicines from £13 billion in 2010/11 to £18.2 billion in 2017/18.
Key recommendations in the report include:
changes to improve patient records;
routinely recording clinical indications at the point of prescribing;
improving handovers between primary and secondary care;
expanding structured medication reviews (SMRs) carried out by PCNs;
developing a national toolkit and deliver training to help general practices improve the consistency of repeat prescribing processes; and
cultural changes to reduce a reliance on medicines while increasing the use of social prescribing and other evidence-based alternatives to medicines.
It also said that NICE and professional bodies should include ‘recommendations for reviewing and discontinuing medicines where appropriate’ in their guidelines and that the MHRA should use ‘post-marketing surveillance’ to ‘support deprescribing’.
The changes will be overseen by a new National Clinical Director for Prescribing, who will lead a three-year programme including research and training to help enable effective prescribing.
The report also recommends ‘deprescribing’ based on improved evidence base for ‘safely withdrawing inappropriate medication, with clinical guidance to be updated to ‘support more patient-centred care’.
Plans also include publishing ‘clear information’ on the NHS website for patients ‘about their medication’ and setting up ‘a platform for patients to be able to provide information about the effectiveness and the adverse effects of their medicines‘.
The DHSC also intends to develop ‘interventions’ to ‘reduce waste’, as part of the NHS’s net zero carbon emissions.
And it intends to commission more research investigating the reasons why overprescribing is ‘more likely to affect older people, people from ethnic minority communities and people with disabilities’.
Health minister Syed Kamall said: ‘This vital review is a significant step forward which will benefit patients across the country, and we will help ensure busy primary care teams are supported with improved systems and resources.
‘Whether it’s helping to change a culture of demand for medicines that are not needed, providing better alternatives and preventing ill-health in the first place, we will take a range of steps to act on this review.’
RCGP chair Professor Martin Marshall said he welcomed some of the report’s recommendations, in particular the ‘commitment to provide further resources and training to support appropriate prescribing in primary care and the development of clinical guidelines to support patient-centred care’.
He added: ‘With our growing and ageing population, with more patients living with multiple, chronic conditions, many people are taking several medications in order to manage their various health illnesses, and the interaction between various medicines is something prescribers will take into account.
‘In most cases, these medicines are necessary, appropriate and of benefit for the patient – but the aspiration to reduce the number of medications a patient is taking, where safe and possible, is a good one.’
GPs and practice teams need ‘better access’ to ‘alternative, non-pharmacological treatments, which can be patchy across the country’, he said.
Professor Azeem Majeed, professor of primary care at Imperial College London and a GP in Clapham, told Pulse it is ‘essential to reduce inappropriate polypharmacy in primary care’.
He said: ‘This requires support from NHS England, such as the provision of pharmacists to carry out regular medication reviews of patients.’
Additional reporting by Costanza Pearce
susanne says
Well guess who led the review. A pharmacist – bet that’s put the cat amongs some of the medical pigeons ,
‘Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions’
PDF, 847KB, 85 pages
Details
The government commissioned Dr Keith Ridge, Chief Pharmaceutical Officer for England, to lead a review into the use of medication and overprescribing.
The review was guided by a short life working group (SLWG), which brought together senior stakeholders from across the healthcare system, together with patient and third sector representation. It looked at reducing inappropriate prescribing, with a particular focus on the role of digital technologies, research, culture change and social prescribing, repeat prescribing and transfer of care.
The review sets out a series of practical and cultural changes to ensure patients are receiving the most appropriate treatment for their needs while ensuring clinicians’ time is well spent and taxpayer money is spent wisely. This includes better use of technology, how to review prescriptions more effectively, and how to offer alternatives to medicines where they would be more effective.
Published 22 September 2021
annie says
National Pharmacy Association responds to overprescribing review
22 Sep 2021
The clinical skills of all pharmacists should be used to tackle the overprescribing of medication, the National Pharmacy Association (NPA) has said, in response to a major government-commissioned review into the issue.
https://www.npa.co.uk/news-and-events/news-item/national-pharmacy-association-responds-to-overprescribing-review/#:~:text=National%20Pharmacy%20Association%20responds%20to%20overprescribing%20review%2022,to%20a%20major%20government-commissioned%20review%20into%20the%20issue.
This includes shared decision making with patients about starting or stopping a medicine, better use of technology, ways to review prescriptions more effectively, and considering alternative medicines which would be more effective.
Overprescribing review calls for pharmacists’ and pharmacy technicians’ skills to be upgraded
https://www.chemistanddruggist.co.uk/CD135526/Overprescribing-review-calls-for-pharmacists-and-pharmacy-technicians-skills-to-be-upgraded
Leyla Hannbeck, CEO at the Association of Independent Multiple pharmacies (AIMp), welcomed the review and said it “should be embraced by the profession”.
She believes that community pharmacy “should be centre stage” to the reforms that will follow the review’s recommendations, as any changes are “likely to impact on the sector and concentrate disproportionately on cost and will thus have a complex and uneven impact on the network”.
“It is therefore crucial that the sector is engaged within this journey and is a key influencer in driving patients’ and the public’s expectations,” Dr Hannbeck added.
The Royal Pharmaceutical Society (RPS) has also welcomed the review. Chair of the RPS English pharmacy board Thorrun Govind said that “pharmacists across the country will be eager to play an active role, working alongside the patients and communities they serve, to reduce the harm that medicines can cause when overprescribed”
annie says
GPhC welcomes overprescribing report
23 September 2021
https://www.pharmacyregulation.org/news/gphc-welcomes-overprescribing-report
We know there is also work underway in Scotland, as outlined in the Achieving excellence in pharmaceutical care strategy and in Wales as part of delivering A healthier Wales long term plan, to help make sure that patients only get the medicines they need.
It is essential that pharmacists working in all settings, including community pharmacy, can both access and update patient records, to make sure everyone involved in the patient’s care knows what medicines they are taking.
tim says
It would appear that prescribers are now to have their feet held to the fire to ensure that there is a rapid, and of course, ‘measurable and monitored’ Rx withdrawal exercise. No doubt targets will be set, and this de-prescribing exercise will produce injuries to patients as a result of lack of understanding of withdrawal syndromes and of their misdiagnosis. Patient safety must be the absolute priority here. Will it be?
No one who has seen the ADRs caused by precipitate withdrawal of psychotropic drugs can feel that it is appropriate for vulnerable elderly care-home residents to have their ‘antipsychotics’, ‘antidepressant’ and benzodiazepines withdrawn without consideration of ‘one drug at a time’, extended taper, and hyperbolic dose reductions. Some of those medicated may have been taking these drugs for many years. Will the suffering of acute, intermediate and chronic (tardive) withdrawal syndromes be recognised, denied or misdiagnosed? Will those precipitately withdrawn from antipsychotics be labelled as ‘psychotic’ when their drugging was entirely for the purpose of command and control? Will AKATHISIA be misdiagnosed as ‘psychotic depression’? Will there be an ‘epidemic’ of Ultra-Late Onset Adult ADHD? Will de-prescribers apply Ashton Manual guidance and hyperbolic dose reductions in benzodiazepine withdrawal, or will simplistic dose reduction result in tonic-clonic fits with pathological vertebral fractures leading to toxic bisphosphonate ‘therapy’? Experimentally, benzodiazepines have been reported to have negative inotropic and chronotropic effects on cardiac muscle fibres (myocytes). (That is: decreased power and speed of cardiac contraction). It is therefore possible that their rapid withdrawal may precipitate infarction (heart attack) via increased strain on the heart.
LESS IS MORE ???
Unless individually planned and monitored expert dose reduction can be achieved, de-prescribing may result in increased morbidity. mortality, and paradoxically, in avoidable increases in prescribing.
The same dangers apply across all age groups. A laudable objective could result in great suffering in both patients and in their families and loved ones.
Dr. David Healy says
Wonderful comment Tim
Anyone who has been around for a while will have seen exactly this happen more than once
As Gandhi said, to do a great evil you must first of all persuade yourself you are doing a great good
D
annie says
‘Bright and happy’ schoolgirl, 15, who took her own life after being given powerful acne drug Roaccutane ‘wasn’t bothered’ by her skin and was not warned about suicide risk, inquest hears
https://www.dailymail.co.uk/news/article-10017065/Annabel-Wright-inquest-Schoolgirl-took-life-given-powerful-acne-drug-Roaccutane.html
Dr Chu said: ‘We are talking about large numbers of patients killing themselves while on this drug.
‘I don’t think anyone can specifically state it does not cause suicide. Many of these suicides come totally out of the blue.
‘With Annabel, she came down in the evening, passed her father, grabbed the dog lead, and hanged herself.”
He said there was research that the drug could effect parts of the brain, leading to depression and suicide.
‘But there is complacency in dermatology because it is so rare,’ he added.
The hearing continues.
Heather R was an expert campaigner, sadly passed.
http://www.ollysfriendshipfoundation.org.uk/
susanne says
Many GPs have been shocked to realise the high level of anger expressed publicly about them. (Many are not, they have enjoyed generating it themselves.) Now they are forced to realise the huge disconnect between how they view themselves and how they are experienced. The anger is not coming out of nowhere yet no real efforts to tackle it rather than blame the public are being made. More funds get poured into ‘well being ‘ services fordoctors instead. It has not just come about as a result of covid but previously there was more reluctance to speak out when the power balance beteen service users and doctors was/is so unequal and support lacking . There are good doctors practicing in surgeries which rarely have to deal with abuse – the rest need the humility to learn from them – but they won’t because their own behaviour is so reprehensible.
No GP leader whether claiming a great relationship or sucking up in public with politicians is naive enough not to realise that they are being needled deliberately by the government. What is the real realationship between them both?. What are their real aims regarding the future of the health services?
Chief executive officer: Tom Grinyer
BMA House
Tavistock Square
London WC1H 9JP
Rt Hon Sajid Javid MP
Secretary of State for Health and Social Care
Tuesday, 21 September 2021
Sent via email
Dear Secretary of State
All at the BMA were deeply shocked at the horrific attack of a GP practice in Openshaw, Manchester, by a
patient which left staff with terrible injuries. This attack comes on the back of escalating anti-GP sentiment
being pushed by sections of the media and a rising tide of abuse and threats directed at NHS staff, especially
in GP practices.
A staggering two-thirds of GPs (67%) have told us that their experience of abuse, threatening behaviour or
violence had got worse in the last year, with half (51%) saying they had been personally verbally abused,
and 67% witnessing violence or abuse against other staff. It is not only GPs that are facing both threats of
violence and violence itself, all those working across general practice are experiencing the same. A survey
by The Institute of General Practice Management found that a shocking 75% of GP staff experienced abuse
from patients on a daily basis, and 13% at least once a week.
This is wholly unacceptable, particularly given the tireless work of general practice staff who have served
the nation assiduously and loyally over the past 18 months of the pandemic. GPs and their teams led the
COVID vaccination programme – the most successful in the history of the NHS – which has delivered 90
million vaccines, saving tens of thousands of lives. General practice is also managing large numbers of
vaccination queries and issues relating to the backlog in secondary care which further adds to pressure
on day-to-day access.
The narrative that GPs are refusing to see patients face-to-face is as dangerous, as it is inaccurate, and
that is why it is so disappointing to see most recently, your public support for the Daily Mail’s campaign
and repeated comments elsewhere. The reality, as you must know, is that with the constraints of the size
of GP practice premises, there are limits on how many people can safely be present in a waiting room
while adhering to appropriate infection control measures. GP practices, in the same way as hospitals, are
using telephone, video and online consultations to assess patients (in accordance with NHS England
guidance) and provide them with physical face-to-face consultations when this is needed. Many practice
premises are too small and poorly ventilated, and with high circulating levels of Covid, we have a duty to
protect our older and clinically vulnerable patients from becoming infected when they attend their GP
surgery.
In addition, there are simply too few GPs and practice staff in under resourced premises to meet the huge
surge in demand that practices are currently experiencing, which will be exacerbated by the Covid
vaccination booster programme. Telephone triage is one way that practices are keeping their head above
water to ensure that patients see the right health professional and make appropriate use of GP time.
Page 2 of 2
Furthermore, while it may suit some sections of the media to portray appointments as being reduced, the
fact is that GPs are seeing more patients than ever, working longer hours than ever. The NHS’ GP
appointments data shows there were nearly one million more appointments in July 2021 than prepandemic levels (July 2019). Whilst GPs are being vilified for offering telephone consultations, they are
doing so purely for the safety of the patients and which in fact our survey shows is more exhausting for
GPs and result in longer days. It is soul destroying for GPs and their staff to hear the narrative that they are
“closed”. I would also note that it was your predecessor as Secretary of State who, in August of 2020,
advocated that all GP appointments should be remote by default, a position that we opposed as being too
simplistic.
Just last week you announced the Covid booster programme, it will be GPs and their practice teams who
will be leading this additional work. Given the magnitude of delivering millions of vaccines over the coming
months, together with increased patient demand during the winter, it is vital that the public are made fully
aware of just how much strain practices are under and how the service may have to change in order to
manage, what is in effect an unmanageable workload. We are not “back to completely normal” and it is
wholly unrealistic to suggest that practices can, under current conditions, return to pre-pandemic ways of
working.
The BMA’s general practitioners committee have written to you twice to specifically highlight the
increasing number of verbal assaults on GPs and primary care staff and have yet to receive a response,
in addition to those calls, I am requesting you:
(i) urgently meet with BMA GP committee leads to discuss our concerns and what support GPs could
be offered to manage the unprecedent rise in workload to meet the needs of all patients.
(ii) attend an emergency summit with the BMA to discuss the unacceptable level of abuse being
levelled against GPs and their staff on a daily basis, and to discuss what further steps, including
new legislation, must be taken to keep healthcare workers safe. We are calling for:
• The maximum sentence for assault against emergency workers to be increased from 12
months’ to 2 years’ imprisonment.
• Verbal abuse against emergency workers to carry a heavier punishment, even when the
threat of physical violence is not present.
• Alongside this, a comprehensive national violence reduction strategy, building on the
existing National Violence Prevention and Reduction Standard, should be developed and
introduced to support staff across both primary and secondary care.
(ii) condemn the onslaught of abuse and media scapegoating of GPs and their staff.
Rather than endorsing a media narrative which scapegoats GPs, show them your support for their
dedication. Without this support more and more GPs will leave the service, making the manifesto pledge
of 6,000 additional GPs inadequate, even if were achievable.
It is too late for the staff in this specific practice in Openshaw, but I call on you now to speak openly and
unequivocally in support of general practice, to meet with our GP Committee Chair, and to attend an
emergency summit to address the situation before it gets much worse. I look forward to hearing from so
that we can begin to work together on addressing the huge challenges ahead with honesty, integrity and
compassion for all.
Yours sincerely
Dr Chaand Nagpaul CBE
ANON says
What can I say?
There are psychopaths creating bad policies, who have no regards for life.
How can man learn from past mistakes if they just keep repeating them?
Humanity has no HOPE!
Miriam Knght says
Hi Annie and Susanne, so many drugs causing long term or permanent harm to get angry about. I have been working closely with Roaccutane (Isotretinoin) campaigners, also Primados/Sodium Valproate and the pelvic mesh campaigners. Several of us were in a Patient Reference Group formed to help advise the DHSC on their response to the recommendations of the IMMDS (Cumberledge) Report published in July 2020. We spent hours discussing (virtually) outcomes and real life stories with senior DHSC and MHRA officials who al promised us they were “listening” and that the patient voice is “vital”. The result? Very little has changed, there will be no redress for harm caused by licensed medications or devices (this was decided before they even met with us) there will be no additional warnings (“no need to emphasise the risks”) and, basically no need for us to have wasted our time.
For a full overview of the Report, what the DHSC said Vs what our patient group suggested see
https://www.patientsafetylearning.org/blog/a-year-on-from-the-cumberlege-review-initial-reflections-on-the-governments-response
tim says
Cumberlege Report. ‘FIRST DO NO HARM’.
Recommendation 6.
The MHRA needs substantial revision, particularly in relation to adverse event reporting and medical device regulation. It needs to ensure that it engages more with patients and their OUTCOMES.
It needs to raise awareness of its PUBLIC PROTECTION ROLES and to ensure that patients have an integral role in its work. (My emphasis) –
Surely, the profoundly disabling outcomes resulting from psychotropic drugs should be independently assessed, and this could identify the MHRA’s failure to protect those who write here.
The MHRA could afford public protection by ensuring that Rx induced AKATHISIA is subject to an urgent Public Health Awareness/Prescriber Awareness campaign. Why won’t they?
Recommendation 3.
A new Independent Redress Agency for those harmed by medicines and medical devices should be created based on models operating effectively in other countries. The Redress Agency will administer decisions using a non-adversarial process with determinations based on AVOIDABLE HARM looking at systemic failings, rather than blaming individuals. (My emphasis).
Our maimed and lost loved ones, devastated by AVOIDABLE HARMS deserve and need redress. I have little hope that it might happen in my lifetime.
susanne says
June Raine is focussed on speeding up the regulation of yet more drugs.J R CEO of MHRA and any of those involved in regulating drugs should be obliged ,as a condition of employment, to spend a day on a locked psych ward to see the effects on people injected with the vile stuff. The public deceitfully is given to believe these effects belong in the days of One Flew Over the Cuckoos Nest. Then on a regular basis as a condition of the job they should be required to actually meet those who have suffered the consequences of harmful prescribing. J R spouts the usual mantra of wanting more ‘patient involvment’ How? Her record ,as was her predecessors, shows a complete disregard for dealing with the harms she has been notified about . Silence is golden for June Raine in the form of more filthy lucre from the ‘Bio Industry’ and no doubt a gong as her reward from the corrupt network which supports the MHRA
UK Regulator To Lose 20% Of Staff In Post-Brexit Cost-Cutting Plans
02 Aug 2021
NEWS
Vibha Sharma
The MHRA intends to drop around 300 roles as it faces a financial crunch after leaving the EU and other pressures.
FINANCIAL PRESSURES FORCE UK MHRA TO DRIVE SAVINGS THROUGH RESTRUCTURING PLANS
The UK’s Medicines and Healthcare products Regulatory Agency could lose around 20% of its 1,200-strong workforce under cost-cutting plans being drawn up to address post-Brexit revenue losses and other challenges.
The Pink Sheet understands that the plan to “transform” how the MHRA operates will lead to a reduction of approximately 300 roles and will take into account different functions across the agency. The MHRA intends to make savings in its operating costs, as well as redeploying and retraining its staff in new areas of regulation and science. The transformation plan, which was conveyed to the MHRA staff in February, is in response to four challenges:
The UK’s exit from the EU with a consequent reduction in the fee income that the MHRA receives from the EU medicines regulatory network.
The MHRA’s role in enabling the Life Sciences strategy.
The recent Cumberlege review, which recommended that the MHRA should focus on patients in all its activities. (Also see “England To Get ‘First Ever’ Patient Safety Commissioner Next Year” – Pink Sheet, 27 Jul, 2021.)
Financial pressures.
Despite the cost-cutting plans, the MHRA has indicated that it wants to continue being a world-class regulator that delivers the right outcomes for patients while it modernizes the services it provides to industry, and remains financially stable.
……
These developments could be of major concern for drug and device companies given the MHRA’s ambition to become a world-class regulator after leaving the EU. In support of its ambition, the MHRA has announced new pathways to attract sponsors of innovative medicines, has joined international work-sharing schemes to speed up drug approvals, and is making changes to streamline the evaluation of clinical trials. (Also see “Brexit: MHRA Joins Second International Work-Sharing Scheme To Speed Up Drug Approvals” – Pink Sheet, 15 Oct, 2020.)
The UK BioIndustry Association (BIA) said it was critical that the MHRA should have the required funding to “implement its international strategy and undertake the new processes they’re putting in place to continue to be a world leading regulator.”
“Ensuring that the MHRA has the necessary resources to be a sovereign regulator… must be a key priority for the Government in the upcoming comprehensive spending review,” the BIA added.
New Fee Structure
Ensuring financial sustainability is a key priority for the MHRA and an update on this front was provided by agency chief June Raine at the MHRA’s board meeting held in public on 15 June.
According to the MHRA’s 2020/21 annual report, the agency’s funding is structured as follows:
Medicines regulation is funded entirely from fees. In setting its fees the agency takes account of full cost recovery rules as set out in the Treasury’s “Managing Public Money” document.
Devices regulation is primarily funded by the Department of Health and Social Care (DHSC), with approximately 10% of its revenue generated from fees charged for services.
The National Institute for Biological Standards and Control (NIBSC) derives about half of its revenue from fees charged for services, including the sale of biological standards, and from research funding. The DHSC provides the remaining funding to finance its public health functions.
The Clinical Practice Research Datalink (CPRD) is jointly funded by the MHRA and the DHSC’s National Institute for Health Research. It is managed and operated by the MHRA with the DHSC having oversight through membership of the CPRD Executive Committee.
Raine said it would take around 12 months to define, consult, legislate and implement a new fee structure for the MHRA.
susanne says
Hi Miriam – Such a common ploy – as you probably guessed ‘the consultation’ was not to be altogether trusted but real respect for what you achieved in showing more of the public that this is what happens And importantly warning more people about the potential risks Some will still be duped but some will be protected by what your group publicised. Thank you. I think it’s very encouraging that groups such as yours with maybe a different focus but common aim are coming together to expose what is going on and to protect others.
susanne says
A snippett from the study- rest on line
The claim that this is the first study is outrageous. There is nothing new in it . It doesn’t matter whether people are in care homes or living in cardboard boxes on the street. Wherever people are out of sight or or uninformed ,this drugging of vulnerable persons will go on. Pharmacists are being flagged up recently – whether they will make a difference I guess we will have to wait and see,
Home>Journals>BJPsych Open>Volume 7 Issue 5>Psychotropic prescribing for English care home residents…
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Access
Psychotropic prescribing for English care home residents with dementia compared with national guidance: findings from the MARQUE national longitudinal study
Published online by Cambridge University Press: 15 September 2021
Abstract
Despite policy pressure and concerns regarding the use of antipsychotics and benzodiazepines, many care home residents with dementia are prescribed psychotropic medication, often off licence. This is the first large study to report psychotropic prescribing and ‘as required’ administration patterns in English care homes.
Aims
To explore the prevalence and associates of psychotropic prescription in care home residents with dementia and compare the results with national guidance.
Conclusions
Antipsychotics and anxiolytics/hypnotics are more commonly prescribed for people with dementia in care homes than in the community, and prescribing may not reflect guidelines. Policies which advocate reduced use of psychotropics should better support psychosocial interventions.
ANON says
I don’t feel sorry for some clinicians.
Many are making $ out of writing up scripts and conducting unnecessary tests and procedures. Some don’t care about the consequences of doing so!
What is the point of having clinicians skype, twitter, email, phone etc………if you cannot be in the physical reading vital signs or looking out for negative side/adverse effects?
This Covid 19 is making some of these clinicians look like heroes when some of them are ready to ‘pull the plug’, without doing some thorough/scrupulous investigations.
Some of the meds people are ingesting are inducing morbid conditions.
Some of you people in the healthcare sector should really be ashamed of yourselves because instead of saving lives you are maiming and killing and hiding behind your professional status to get away with murder!
If only the dead could speak, I am sure they would have a field day with a lot of health professionals who have wronged them!
annie says
Charles Medawar, of pharmaceutical watchdog Social Audit, said not just Glaxo but also the MHRA had “a great deal to apologise for”.
He said: “They say the decision not to prosecute was decided by the inadequacy of the law.
“My reaction is that before launching a million-pound investigation it might have been a good suggestion to check what the law actually says.”
Accusing the MHRA of a ‘naive and absurd’ level of trust in drug companies, he said: “The deviousness companies employ when promoting their drugs and minimising their side-effects is really quite extraordinary.”
https://www.dailymail.co.uk/health/article-527837/Seroxat-makers-escape-prosecution-despite-failing-reveal-link-teenage-suicides-FOUR-years.html
There was nothing unlawful about Wendy Burn and David Baldwin writing a letter to The Times newspaper about a short withdrawal with antidepressants, it was just extremely bizarre and very stupid. What sort of organization who feels they have an important announcement to make writes it in a letter. It caused a huge fuss.
Shortly after that episode, a podcast was aired with Simon Wessely and Clare Gerada going out of their way to laud the safety and effectiveness of antidepressants.
After a while, Stopping Antidepressants was produced by the Royal College of Psychiatrists.
Then, thanks to Dee Doherty, Louis Appleby, Suicide Prevention, stated that he was aware of akathisia and the government did not want any action. This was not qualified. Did he mean MHRA or NICE or Matt Hancock.,
There is undoubtedly pressure not to reveal the true nature of SSRIs, violence, homicide and suicide and severe harms and it is avoidably made complicated. Law and Medical Ethics, strident opposition from medical leaders who don’t have any facts at their fingertips, doctors who maybe draw in the air that antidepressants are safe and effective and patients who trust their doctors not to give them dangerous medications.
On the Victoria Derbyshire programme Simon Wessely was caught on camera lolling on a sofa, his eyes just short of rolling when Leonie Fennell came on to speak about her son Shane’s violent reaction and death from an antidepressant. As he noticed the camera on him, he immediately sat bolt upright feigning interest. On a Maudsley Debate, he was accused of taking money from pharmaceutical companies; shoulders heaving, he was apoplectic with rage. This debate sparked his wife Clare to stand up in the audience and heckle; as this was a debate with a vote, any normal debate would be cancelled as interfering with the vote.
Wendy Burn suggested that it was GPs who provided the most helpful input for Stopping Antidepressants, ignoring Wendy Dolin’s presentation on Akathisia at the RCP Conference.
In the UK, there are Narrative Controllers who influence.
They go beyond their brief and give out summary opinions.
It is unlikely they would do very well under cross-examination…
From the Grassy Knoll
https://davidhealy.org/from-the-grassy-knoll/
“Thanks Sound track is rather avant- garde !”