Yet another study has been published showing that prescription antidepressants are no better than snake oil – that is to say, placebo, or sugar-pill – for treating mild to moderate depression. Yet in 2008 – the latest year that figures are available for – UK doctors doled out a staggering 36 million prescriptions for antidepressants to patients – almost enough for one prescription for every adult.
How can this be? To answer this question, we have to go a bit further than the usual – and highly important – profit motive of Big Pharma. We have to ask the question: why is it so easy for Big Parma to shift 36 million prescriptions a year? The answer lies in the history and nature of General Practice – which is of course where the vast majority of these prescriptions are issued.
Historically, the medical profession had three main branches. First there were the physicians, traditionally university educated learned gentlemen who would arrive and leave by the front door. They provided opinions (diagnosis), and sometimes ‘physic’. Then there were the surgeons, descended from the barber-surgeons (and so not learned, which is why to this day we call surgeons “Mr” rather than “Dr”), who would arrive by the tradesmen’s door, and cut you open on the kitchen table. And then there were the apothecaries – the corner shop chemists who you would visit, to buy pills and potions, and brightly coloured remedies, much of it snake oil.
Over the last century, and particularly with the introduction of National Insurance and then the National Health Service, these three branches of medicine became assimilated into the organisations we see today. The physicians and surgeons became increasingly hospital bound, and provide secondary care, while the apothecaries evolved into a new form of practitioner – the General Practitioner – who would provide primary care in the community, from their own premises. The corner shop chemist became the Surgery on the Corner.
Because a visit to the apothecary was at heart a shopping trip, no appointment was needed, and the encounter brief. The customer would describe their problem, and the apothecary would provide a remedy. Goods and money would change hands. The customer would not expect to come away empty handed…
With the full implementation of the NHS, the payment side of the equation was done at a remove by taxation. But in other respects the encounter remains largely unchanged. That is why general practice consultations – until recently – did not require an appointment, are still short, and why there is so often an expectation – on both sides – that something, usually a prescription, will change hands.
Dr No is not for a moment suggesting that all GPs are closet shopkeepers. But he does think old habits die hard. Until recently, the ‘goods’ were antibiotics. Nowadays it appears they are antidepressants. How else could we get to 36 million prescriptions a year for something that is no more effective than snake oil?