The title of his book is already a declaration of intent. Are we intoxicated because of so much medication?
Just look at the data: in 2022, Spanish doctors wrote 1.1 billion prescriptions. Out of every ten people, three take a drug for sleep or depression; two or three take an omeprazole, and two take a cholesterol medication.... What I have seen in reviewing the literature is that most of the drugs are prescribed unnecessarily, without taking into account the harmful health effects that this has.
But many patients are not happy when they leave the office without a prescription from the practitioner....
There is a bad perception that if we are not prescribed something, it means that we have not been listened to. The doctor may simply diagnose anxiety, depression or insomnia and prescribe a drug the first time around, but that is a mistake.
Real medicine should consist of exploring and questioning the patient for a longer period of time in order to understand his situation and offer him guidelines that can improve his problem before deciding on a drug. And when a drug is necessary, it may be necessary on an ad hoc basis, but this lack of time on the part of professionals to carry out adequate follow-up means that many treatments become chronic with serious harm.
Does that make us sick?
Undoubtedly, we suffer a silent epidemic of adverse drug effects, which in Spain are the cause of more than half a million hospitalizations and 16,000 deaths a year, as well as thousands of cases of diseases as varied as serious bleeding, fractures, pneumonia, heart attacks, stroke, sexual dysfunction? And I say it is silent because these data do not appear in official statistics; not because anyone wants to hide them, but because they are constructed in a way that prioritizes the immediate cause of death, and not the mediated causes of death.
Is the cure sometimes worse than the disease?
Yes, it is. On one side of the scale are the beneficial effects. If you take an analgesic, even if you do not know the origin of the pain, at least it relieves the discomfort. On the other side of the scale are the adverse effects, and it is not worth taking the risk of them appearing if the drug is not going to be effective.
For example, cholesterol drugs do not provide any benefit to those who have not suffered a heart attack or stroke, and yet they frequently cause adverse effects, such as muscle pain or diabetes. In this case the balance is tipped to the side of adverse effects.
Is our healthcare system trying to kill flies with cannons?
The reality is yes, even though those flies could be reduced with a good conversation with the patient. Treatment should sometimes be a dietary or habit orientation and not a drug.
Is Spain an exception or is this a global problem?
It is a global issue, because the market is increasingly concentrated in fewer pharmaceutical companies and these have similar marketing orientations in all countries. It is striking, for example, that, despite our Mediterranean diet, the consumption of drugs for cholesterol is comparable to the European average, or that we consume as many drugs for depression, or more, than in the Nordic countries? This shows that drug intake is not adjusted to the health needs of the population, but to the greater or lesser success of the marketing departments of the laboratories in each country.
You advocate being more skeptical about drugs...
We should be skeptical about medicine in general, because we think we know everything about the organism, but we are ignorant about aspects such as the microbiota.
We need more collective humility. And we should be more skeptical about the good things that laboratories tell us, because they are accountable to their shareholders and the more they sell and the more expensive, the better.
What is not known about the workings of this little world?
Little is said about the ins and outs, and this should be the subject of public debate. It is the whole drug chain, from the laboratory that squeezes to sell, continuing through the State, which regulates, in my opinion, insufficiently or inadequately the use of drugs, continuing through a health system that only leaves the professional time for quick prescription, without forgetting that they are doctors whose continuous training is done through courses that, in more than 90% of the cases, comes from the pharmaceutical industry.... It is clear that it is not only the patient's fault.
But without investment in innovation, which usually comes from the industry, we would not have achieved major medical milestones, don't you think?
Indeed, innovation and science are necessary, but they can be manipulated, with harmful consequences for patients. In the book I explain that the contribution of pharmaceutical companies to the development of innovative drugs is in fact lower than the public contribution.
La Razón