Heroes Not Zombies

I was struck by a recent study looking at how much psychosis patients with schizophrenia (SZ) experience on anti-psychotics.

At each follow-up assessment over the 20 years, a surprisingly high percentage of SZ treated with antipsychotics longitudinally had psychotic activity. More than 70% of SZ continuously prescribed antipsychotics experienced psychotic activity at four or more of six follow-up assessments over 20 years. Longitudinally, SZ not prescribed antipsychotics showed significantly less psychotic activity than those prescribed antipsychotics . . . the condition of the majority of SZ prescribed antipsychotics for multiple years would raise questions as to how many of them are truly in remission.

In other words, not only do most patients with schizophrenia who are prescribed anti-psychotics continue to experience psychosis, but those who aren’t prescribed them experienced “significantly less psychotic activity”. What makes this study particularly unusual is that it was conducted over 20 years. This is highly unusual but more real life than the vast majority of studies which are quoted to give a drug “evidence based” status. Maybe it’s just not a good idea to keep somebody on the same drugs for decades?

That got me thinking about a related issue of prescribing drugs to healthy people to try and prevent disease. Think about statins for example. I found a good summary here.

Experts calculate that to save one life, or avoid a non fatal heart attack or stroke, you would need to treat 11 high-risk patients for 10 years.To save a life or avoid cardiovascular morbidity among low-risk patients the number you need to treat increases to 23. But different studies have looked at different types of patients and have yielded different results, so it is difficult to know if this pans out.US researchers estimate that for every 100 people without known heart disease who take statins for five years, 98 would see no benefit, and only one or two would avoid a heart attack that they might not have otherwise

Just read that last phrase again “for every 100 people without known heart disease who take statins for five years, 98 would see no benefit, and only one or two would avoid a heart attack that they might not have otherwise”. Seriously? Is this a great way to a healthier life, if you don’t already have heart disease? Well, for 98 out of 100 people, the answer is “no”. And what about the one or two who might avoid a heart attack? Nobody wants a heart attack, but time and time again, a “non-fatal heart attack” is a turning point for people. They make serious decisions about life style and change direction. They re-assess what is important to them, and if they stop smoking, cut back on their alcohol consumption and/or start exercising for 30 minutes a day, then the health benefits they will experience go way, way beyond the reduction in heart disease risk which a statin would bring.

We just can’t go taking one drug after another to avoid one disease after another, can we?

Doesn’t it make more sense to only take medication for short periods when it is really necessary, and to start to lead fuller, healthier lives right now, no matter what our current state of health?