IT is widely accepted that ‘preventive’ measures, where feasible are fully acceptable and indeed desirable for general benefit. Identifying clinically ‘yet unexpressed ’ ailments eg breast and cervical cancer are useful and do save lives in many cases. However one must decide what is possible and what is probable. For example it is possible there might be an earthquake any time anywhere but that is not very probable in the UK. Whilst it is extremely probable that there will be rains in Lancashire during the months of December and January.

In the health care field over the last couple of decades there has been a move to make early diagnosis and often ‘to intervene’ with medications. In some situations this may be absolutely correct; the problem being nipped in the bud. But that approach is not always appropriate and in some instances may be harmful.

The so called ‘health check’ measures often make the professionals somewhat ‘mechanical’ and sometimes encourage them to intervene unnecessarily in response to government initiatives and financial rewards. Whilst I am fully and whole heartedly in favour of health checks and early detection of ‘silent’ and yet unsymptomatic preventable ailments, I am totally against use of strong medications on somewhat flimsy grounds. This practice is being noticed frequently and reported even in the wide lay media.

Comments have been made regarding the usefulness of statins to prevent heart disorders. The overall risk/benefit ratio has been measured - often with a negative finding. There are far more reported adversities compared to the overall benefits. Whilst someone with high lipid levels and/or a strong family history should definitely be treated, is it really useful to put someone on medications just to treat his laboratory report.

Similar negative outcomes have been observed in the fields of blood pressure and diabetes. It seems increasing number of people are being prescribed strong medications just to rectify their blood reports and marginally altered clinical picture. This has been even more obvious among the 70 and 80 year olds. Of course there must not be any discriminatory practice against older people, but one must also be very careful about the total risk/benefit effects of medications. Perhaps some gentle advice on life style changes and a degree of monitoring would be a more sensible approach. A few instances of serious adverse effects of medications have been reported eg bone fractures from falls due to excessive reduction of BP and attacks of hypoglycaemia from overzealous use of oral anti-diabetics.

Writing a prescription is easy; rather than taking regular care and paying attention to the people.

As already mentioned,prevention, where feasible, is the best and the most wise option and also the cheapest but not overzealous medicated intervention just to influence the lab report and to achieve the target levels of health.

Perhaps a somewhat modes, relatively soft pathway is needed; some academics call it a bazaar rather than a cathedral approach. Most guidelines tend to be inflexible and fail to address the clinical complexity and the possible risks. A fast and frugal knowledge tools need to be designed to support a dialogue, deliberation and proper understanding of the consumers who are the ultimate targets and beneficiaries.

Arup Banerjee