Episode 1 The Doctor Who Gave Up Drugs

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'My name is Chris van Tulleken.'

Gastric bleeding, sir?

'I'm a doctor looking for answers to a crisis in medicine

'that threatens us all.'

It can erode your stomach lining and then you bleed from your

stomach, and it kills a certain number of people every year.

Every year, doctors hand out over a billion prescriptions.

We're just prescribing more and more and more pills.

Aaaah.

'That's 15 courses of medicine for every man, woman and child.'

You've got a headache, you take paracetamol.

You've got a backache, you take co-codamol.

That is an overdose.

Drugs do save lives, but this growing binge

on medicines is dangerous.

How could this ever be good for a human being?

'Millions of people suffer from side effects.'

I was waking up depressed.

And thousands die every year.

Overuse of medication is one of the most serious problems that we face.

'I believe there's another way.'

Today is the last day that you are going to take these drugs.

OK.

I'm going to take over part of a doctor's surgery

where I'll replace the drugs by treating patients without pills.

From chronic pain...

Oh. ..to depression.

But with worried doctors...

Stopping things can potentially be downright dangerous.

..and patients who want the drugs I'm trying to stop.

Most of those pills do not work at all.

But they're painkillers.

Persuading Britain to go cold turkey could be the hardest thing

I've ever done.

Intensely depressed about...

about how to make a change.

Ah, my pills. Thank you. OK.

'I've been a doctor for 14 years,

'and I'm increasingly alarmed by the steep rise in prescription rates.

'They've rocketed by over 50%.'

So I've ordered bags of pills

and I'm going to try and work out how many of these things does a

typical person take in a lifetime.

'As babies, we're given essential vaccines and more than likely

'several doses of antibiotics.'

And then the only other thing that a well nought-to-ten-year-old

is going to take, really, is drugs that reduce fever.

That's about 400 pills in there.

That's the number of doses of drugs a well,

normal child gets in the first ten years of its life.

'All good. But by the time we hit our teens,

'it becomes utterly normal to pop pills on a regular basis.'

1,500 painkillers.

'From oral contraceptives to antibiotics.'

That's around about 4,000 pills or doses,

so there's the second decade of your life.

'Things ramp up towards middle age.'

So, 20 to 50 - what drugs might we take?

'And at some point it certainly wouldn't be unusual

'to hit a bout of depression.'

In Blackpool, one in five people

gets an antidepressant prescription.

That's a staggering number.

'As you reach 50, you might be taking 1,000 pills a year.'

This is what we take from 20 to 50.

'But things really get going when we hit our 60s,

'with a tsunami of drugs designed to prolong life.'

Just two pills a day to manage that blood pressure.

'In the course of a lifetime,

'a healthy person could easily consume up to 100,000 pills.'

I mean, this is just a staggering amount of drugs.

It's important to say that some of these drugs do good -

they save lives, they make you feel better.

But they can all do harm, all of them.

That harm comes in the form of side effects, from headaches

'to stomach bleeds.

'In many cases, they can be worse than the condition

'they're supposed to treat.

'I believe we should be turning to new research that suggests that many

'common illnesses are best treated without drugs.'

I want to be clear, this is not some personal crusade against all

medicines. There are drugs that benefit and save countless lives.

But...

modern medicine has got to a point where we treat millions of people in

this country with drugs that the science says don't work very well,

for many people they don't work at all,

and they do massive amounts of harm.

They kill people.

'I'm going to work where more than half of the NHS drugs budget is spent -

'a GP surgery - but instead of handing out drugs,

'I'm going to take them away.

'I've found a nearby clinic that's willing to let me test my theory.'

Churchill Health Care, Pat speaking. Can I help?

Churchill Medical Centre is in Chingford, Northeast London.

Mrs Collins. Going to pop this in your ear.

The doctors here agree that over-prescription

is a serious national problem,

and they're keen to see what I can do about it,

but they aren't all convinced that I'll find answers

by taking patients off their drugs.

I guess the worst case scenario would be somebody died.

The notion that Chris is going to come in and just completely take

people off drugs and then happily manage them without these things,

I think, is ludicrous.

It would be lovely to see if he could do it.

I don't think it's going to be a walk in the park.

This is great. It's great, I'm here.

First day at work.

New school.

Right.

Hi. 'The staff have gathered to hear my plans.'

Thank you very much for making the time to see us today.

So, I guess what I want to do is set up a clinic within this practice

where I will attempt, with guidance and advice,

to stop people's prescriptions.

It's quite a risky idea.

What is your instinct about this as a problem,

as a thing that needs addressing?

Are you optimistic?

Everyone's very poker-faced, I have to say.

THEY LAUGH

So the principle behind it, you know,

I don't think you're going to have anyone in the practice

that turns round and says, "No, I think that's a bad idea."

Oh, great. A bit of me was thinking some of you might

just think I'm mad.

I mean I've read all... I didn't say we didn't think that.

Great.

It's going to take a while to convince them

that I know what I'm doing.

So, I'm not a GP.

Being a GP is a highly skilled medical specialism, really,

and I can't just turn up and do it unsupervised,

so I've been given a mentor, called Kam, who I'm about to meet,

and it's a bit like going back to medical school, so...

Dr Kam Seehra is one of the practice partners.

Kam. Hi. Hi.

I'm Chris. Kam.

How you doing? Thanks very much for looking after me, in advance.

What do you think of my plan?

I would love for you to find some alternatives that are safe,

I would love for you to find some alternatives that are safe,

that are viable and that we can carry through,

but I am quite sceptical.

I think it's worth a go.

I guess that's where I'm left.

Is she in any pain?

This is a busy practice with 14,000 patients and 15 full-time doctors.

I need the drugs? Yeah.

Last year they handed out nearly 200,000 prescriptions.

I'm hoping to help them cut the amount of drugs

they give out and make changes that could be taken up

across the country.

So, we only have ten minutes per patient and in that time, you know,

we're trying to address their...

the concerns that they've come in with,

so it's quite a lot to be able to manage in ten minutes.

Kam has suggested I start by watching him treat patients

so I can see the problem for myself.

Hi. Hi, come on in. How can we help?

I think I've got gout.

It's really painful.

'Gout is a type of arthritis that causes attacks of severe joint pain.

'The medication used to treat it can cause ulcers and, in extreme cases,

'stomach bleeds.'

So, we'll give you some naproxen, which is twice a day,

which makes it easier for you when you're working.

Yeah. And we'll give you one stomach protection tablet.

All right? Lovely. Thanks very much.

Thank you. Take care. Cheers, thanks.

Do you think you could have avoided giving him those two pills?

Well, he's a builder, he's on his feet all day doing heavy lifting.

I think he needed those tablets.

It's pretty hard to argue with that. Absolutely.

And those drugs were dispensed in just about the most

responsible way I can imagine.

Come on. I'm Chris. How's it going? Good.

Have a seat. Right, how can we help?

I need the dizzy pills again.

I can't wake up in the morning properly, because it makes me sick.

How often are you vomiting? Every time I'm dizzy.

Let's have a look at your good one first.

'In just ten minutes, Kam must examine the patient,

'find out what's wrong,

'decide the treatment to give and discuss it with them.

'All before the next patient arrives.'

That's for a couple of months, OK?

Hopefully it should improve.

Thanks a lot. See you later, man. See you. Have a good day.

So, do you think that giving him drugs was the right thing to do?

I mean, he's vomiting on a weekly basis and that's not going to be

healthy, so this, for me,

something that's going to actually make him feel better,

is an easy medicine to be giving.

'As the day passes, I notice a pattern.'

For now, we will give you some treatment,

some antibiotics to treat this.

So, more drugs, Kam. Yeah, more drugs.

If we don't treat him, he could die.

We're trying to nip it in the bud, really.

I've got a serious ear pain.

So, we're going to give you a spray.

Steroids and antibiotics.

Every single person walked out of here with a prescription, virtually.

Is that right? When you're there in front of someone,

you can cite all the evidence you like,

they're still there and they're still in pain, for example.

You still have to manage that and it's very difficult to say,

"Well, the evidence suggests that we don't treat you for this,

"and so we're not going to give you...

"You're going to carry on in pain."

No-one could deny that he is a superb doctor,

and yet he saw 40 patients and he dealt out 39 prescriptions.

When you look at each one of those decisions,

it feels like, "Well, yeah, that's OK, I'd do the same thing."

But when you look at that big picture of everyone

who comes in walks out with drugs, that can't be a good thing.

'I can't quite put my finger on what's going wrong.

'To find out, I'm meeting one of Britain's most senior doctors.'

Hi, Muir. How are you? Good.

Well, it's very nice to see you.

'So, Muir Gray used to be Chief Knowledge Officer for the NHS.'

Overuse of medication is one of the most serious problems

that we face in health care in every developed country.

How have we got to a point where

we have too much medicine?

How has it all happened?

We've got these 40,000 doctors sitting in a room

with ten minutes to get closure.

We've got patients who we've led to believe that the solution

is a prescription and we've got nothing else to offer them.

So, surprise, surprise, how do we finish off the consultation?

The pressure's terrific to finish the consultation

with a prescription, and therefore we need a revolution.

We need to change the way we think

and we need to change the way we do things.

Morning. Good morning. Morning, Morag.

'I'm going to start my revolution by helping patients

'who've become victims of the system.'

She's room three. Next-door to Doctor Simmons' room.

The surgery soon finds someone that they hope I can help.

Wendy? Chris van Tulleken. Don't worry at all, it's fine.

Have a seat there. Thank you.

I've got a major problem with my shoulder.

It just feels like my whole shoulder and my arm,

just feels like pins and needles in my hand.

I can't pick anything up, I can't grip. It hurts.

'Wendy's been taking painkillers for the past 20 years

'to deal with chronic pain in her shoulder and back.'

It's sort of here, the pain.

'Despite physiotherapy and referrals to specialists,

'her doctors still can't figure out what's wrong.'

OK.

'She's now being prescribed increasingly powerful drugs.'

What helps? Does anything help it?

Diazepam. It's a highly addictive...

I really begged for them and they wouldn't give them to me.

It's quite dangerous, yeah. I was like, "Please give me more."

The problem is you have to take more and more and more and more...

Really? ..to get that same effect.

Right, OK. And it becomes extremely toxic, and when you stop taking it,

it's really dangerous.

Right. 'Consuming these drugs long-term

'could be causing Wendy real harm.'

Thank you so much. It was very nice to see you.

OK, we'll be in touch. All right, thanks. Cheers, bye. Bye.

'I want to help her find another way.'

Prescriptions for painkillers have shot up

by nearly 50% in the last decade.

They are now some of Britain's most commonly used drugs.

Wendy is the normal.

She's taking stuff that's mainly over the counter,

it's available to all of us and it's the stuff we all take a huge amount

of, but for the most part it doesn't work very well.

'A recent review of research into over-the-counter painkillers

'found many only work about half the time.

'I wonder if the painkillers are really working for Wendy?

'To find out more,

'I'm abandoning the usual ten-minute appointment and making

'an old-fashioned home visit.'

DOG YAPS Beware of the dog.

DOG GROWLS Oh, hello. Who are you?

Jasper. Hi, Jasper. Hi, I'm Chris.

Thank you for having me. That's OK, you're welcome.

And who are these guys? This is Jasper and Boo.

Boo. Hi, Boo.

'Wendy lives with her husband Alan and her daughter Jade.'

I feel like I want to go straight to your drugs cabinet. OK.

Let's not do that, let's have a cup of tea.

Let's have a cup of tea first.

You've been off and on painkillers for 20 years...

Yeah. ..for this... Yeah, yeah.

The last two years, nearly every day, I've been taking painkillers.

But it's never really gone.

Are you in a worse state now than you were 20 years ago?

I'm definitely worse now than I was.

Definitely. Right.

So, talk about the drugs. Where are the drugs?

OK, so I've got my tablets in here, if you want to see them.

Well, get it all out, come on. This is the cupboard of shame.

Co-codamol.

'Wendy takes a daily cocktail of three different painkillers.

'Paracetamol, ibuprofen and codeine.

'They're supposed to work by interfering with pain messages

'sent to the brain.'

Can we lay it out? Do you mind if I pop out, for the whole day,

pop out the pills that you would have?

Yes. OK.

'Taking a cocktail of painkillers like Wendy does every day

'can produce more of an effect.

'But in cases where they don't work,

'patients can end up taking bigger and bigger doses.'

Now we've laid it out, what do you think of that?

I know...I did think to myself,

especially in the morning when I take that one as well,

and I was thinking, "Oh, my God, this is a lot of pills I'm taking."

When you do take all of them,

cos you're having a bad day,

does all the pain go away, are you completely better?

No. Basically, it sort of eases off

and then I know it's four hours later and I have to

start and take them again.

OK. I'm surprised at the amount of drugs you're taking.

I didn't know you were taking that many daily.

That's only when I've got a really bad back.

But then I've never seen you without a bad back.

You've never walked through that door and said,

"I've just had some drugs, my back feels better."

Every time you come through that door it's, "My back's really bad."

I know, because I need to take some more drugs.

Well, you've just had some, probably.

No, I take them every four hours, I don't...

Exactly. You told me, "Don't worry about four hours, three hours..."

I didn't know you was taking that amount, though. I didn't realise...

I thought you was taking one pill a day or something...

I must admit, to be honest, I was taking three of them.

Oh, my Lord, really? Sorry, I thought you meant

you were actually only taking them three times a day.

What you mean is you were taking three, four times a day?

Yeah. That is an overdose.

'I'm worried about Wendy's excessive drug use,

'and I want her to understand the dangers.'

So, ibuprofen can damage your kidneys.

Right. Especially at the dosages you're having it.

OK. The paracetamol could damage your liver.

So, if you hurt your liver, we can't do anything.

You either get a transplant or you die.

Right. So, the number one cause of acute liver injury in this country

is paracetamol overdose.

OK. The other thing I think I would really like to try

and do to you is prove to you that the drugs don't work.

They're painkillers.

So they must work, they get rid of the pain.

You're in as much pain, I believe, with them or without them.

No, I'm in more pain without them. That's got to be a mental thing.

Are you saying that I'm mental? No, I think that's what you're

telling yourself... It's in your head. ..cos every four hours,

you need those drugs. No, it's not in my head.

The pain is real, I'm telling you. No, no, no. No.

I don't dispute for one minute the pain is real,

all I'm disputing - I don't think the painkillers

are giving you as much relief

as what you're saying or thinking they are.

OK, Dr Alan(!) No, I'm just saying.

Would you be willing to let me just take away all the drugs?

If I can have another solution and get rid of the pain,

then I'll be happy to do that.

When was the last time you went and saw a physio

and did some exercises to help your shoulder?

I normally do, like, sort of a few stretches and whatever,

and then you just forget about it and get on with the day.

On an honest note, how many times have you come to this house

and seen Mum doing any exercises for her back?

I don't know. You don't. I do them in the bedroom.

You'll go along in the car and you'll do...

"I just need to do these exercises."

She'll be in the car and she'll go... Yeah, she does that.

The truth is, Wendy, you'd rather go and pop a pill

than doing them exercises. No, no, when you're not here...

This morning, how many...

Did you do exercises for your bad shoulder?

No, I... Yesterday, did you do exercise...?

No, I must admit...

No.

See you, bye. Bye, Jasper. DOG BARKS

She's done bugger all other than take pills, that's what I think.

She's done nothing.

She's spent a huge amount on people poking and prodding and making that

pain worse and she needs to do some graft, some exercise.

And the other thing is - those painkillers don't work.

I thought, "Oh, maybe they do." Those painkillers do not work.

'I just need to think of a clever way to convince her

'to stop taking them.'

'Wendy's pill habit is one part of a bigger problem.

'In my day job, I'm an infection doctor and a scientist,

'and I'm now facing the most terrifying consequence

'of our pill-popping culture - antibiotic resistance.'

By overusing antibiotics, we generate antibiotic resistance,

which spells the end for life as we know it on this planet.

That's a doomsday scenario.

'They're vital for treating and preventing bacterial infections.

'Without them, many medical procedures simply won't be possible.

'But we've prescribed them so much that the bacteria they should kill'

'have evolved to resist them.'

People don't quite get this.

If we run out of antibiotics,

it's not that we can no longer treat your, you know, infected finger.

It's that we can't do any more bone surgery, we can't treat cancer,

we can't run a hospital, you can't have an intensive care unit,

you can't do anything.

'Drug-resistant infections are becoming increasingly common

'in hospitals.

'Unless we cut antibiotic use and slow the spread

'of these new superbugs, it's estimated they'll kill

'ten million people a year by 2050.'

I'm calling from Churchill Medical Centre.

One of our patients has written to us, sorry.

Catherine, are you...? Are you in a meeting?

Yeah. Free sandwiches here in two minutes.

Do you want to come to the...? I'll come in a couple of minutes,

if that's all right? Fine.

'I've discovered this practice has one of the highest antibiotic

'prescription rates in the area.

'I've asked for a meeting to discuss what we can do about it.'

I guess this is the first time I've spoken to them,

and I feel like I am going to fairly bluntly criticise them.

And that's really uncomfortable,

but I guess I do have the authority that I am an infection doctor.

Phil, have a seat, grab a sandwich.

So, of the 45 practices,

you are the ninth biggest prescriber in the local area.

I guess that begs the question - why?

I don't think we've got anybody who is very cavalier

with their prescribing.

I'd say 99.9% of the time they are appropriate prescriptions.

I do come from a position where I think we do, in general,

overuse antibiotics.

We probably underreport side effects,

and resistance is such an enormous problem

that we should take every step we can.

It's all very nice sitting at the front and saying,

"You give too many antibiotics."

I challenge you to come and sit with me in surgery,

see the patients and see what you can do, and, yeah,

try and resist. Fine. Great.

I mean, how hard can it be?

'This morning I'm taking Kam up on his challenge.'

'Nine out of ten GPs feel pressurised

'to prescribe antibiotics.'

'I want to see if I'll be able to resist.'

Today's my first day as a GP,

and it's very nerve-racking, because, of course, I'm not a GP.

'Today I'll be the doctor in charge and Kam will be in the room

'in case I need help.'

I think coming in with his own agenda,

what he will really find difficult is patients have their own agenda

and when those clash, then that doesn't lead to a good outcome.

You ready? No. Of course I'm not ready.

Am I ready? I'm not ready at all.

You've done clinics. I know, I don't know why...

This is not a big deal, I can see a patient.

Right, here we go. OK.

Why is my mouth dry and my palms sweaty?

OK, Nick Kearns, right. Have we called him?

Nick Kearns.

What's up today? Why have you come to see me?

Well, I've had a sore throat and generally felt pretty rough

for about a week.

What do you feel you would like out of today's consultation?

Antibiotics to just completely eradicate it. Get rid of it.

OK.

'Antibiotics only work with bacterial infections,

'but they can be given unnecessarily to patients

'suffering from viral infections.'

It is a bit red.

But there's no pus there.

'This patient appears to have a virus

'which should clear up by itself.'

I mean, I think you are just going to get better,

this is going to be self-limiting, and in your case antibiotics

might cause more problems than they'll solve. Yeah.

Is that all right with you?

Yeah, if you think I'm going to get better on my own.

Great. OK. Very nice to see you.

And you, yeah. Thanks a lot.

It's my first success and I'm feeling quite smug.

You know, that was a fairly simple case,

someone came in with a sore throat and he was very amenable.

I'm sure the next one is not as easy.

Carla? What's up?

OK, well, basically I've had an ongoing problem with my toe.

'It's going to need re-operation.'

So, what would you do? Give a course of antibiotics?

What would you do? Well... OK.

Does it need antibiotics?

'Even with many bacterial infections,

'patients get better over time without drugs.'

Well, I guess I would wonder if this is actually going to go away

with antibiotics, bearing in mind we've got a lot of pus there,

would I put a hole in there and see if it will drain out.

Last time, I believe, I had a course of antibiotics

which helped really a lot.

I start my placement as a student nurse in a couple of weeks.

Fine. There's no way you're going to be able to make that,

so we'll prescribe some antibiotics.

'Perhaps I should have held out,

'but the antibiotics may prevent serious complications.'

Say ah. Aaaaah. She usually gets better with antibiotics.

'And when this mum wants antibiotics to help her child recover

'in time for exams...'

So, I'm very happy to give you antibiotics

in this particular instance.

Are you happy to hold her while I just have a look? Yeah.

'Some bacterial infections can kill if not treated.'

Oh!

'And without a test to be certain it's not bacterial,'

'I prescribe antibiotics just to be safe.'

So, we'll give you some eardrops that have an antibiotic in them.

There is your prescription. Thank you.

The waiting. I'm literally talking to myself with it,

you know what I mean? Really bad.

'It's the end of the day and I come across a patient

'that I'm reasonably confident doesn't need a prescription.'

There are risks with antibiotics.

No, as I say, I do need them.

OK. That's the way I look at it.

But to just walk out with nothing, I wouldn't feel safe.

That's what I'm trying to say.

97% of patients in the UK who ask for antibiotics are prescribed them.

Unless you're certain the infection's not bacterial,

it's the safest thing to do.

Thank you very much for your time. All right. Thank you.

I did not want to give him... Yeah. ..a course of antibiotics.

OK. And I gave him a course of antibiotics.

And I definitely would have stepped in if you had said no.

Someone with so many other medical problems,

I would really be keen not to let them get any worse.

Yeah? So, that's what we're really...

You know, that type of patient

is what you're really trying to deal with.

'It's been a difficult day.'

I feel...

I'm kind of all at once in awe of what has to be done in a day -

and Kam, bear in mind, is still in there doing his stuff -

and intensely depressed about...

..about how to make a change.

'This drug problem can't be solved by just saying no.

'I'm going to have to think of a different approach.'

Is that the only thing you're needing? Can you do 3:30?

Can I have a prescription for a lady...

I've found another patient.

Sarah isn't registered at this practice,

but she's heard about my work here and wants my help

to come off her meds.

Sarah. Come on in.

'She's 24 and she's one of over five million people in this country

'who take antidepressants.'

There you go. Thank you very much.

I've always just felt very low and very depressed and...very uptight.

And then when I got to 16, I went to the doctors

and I got myself diagnosed with depression and I got put

on medication from that age to try and kind of level myself out.

Why do you want to stop your pills?

I feel like they mask everything,

but they're not getting to any root of any problem,

they're not really resolving anything long-term.

OK. What happens when you try to stop them?

I have really, really bad downs.

OK. And I don't really see any other way of

stopping the downs apart from going back on the antidepressants.

It's thought that antidepressants

alter levels of brain chemicals known as neurotransmitters,

which can influence mood.

Have you ever read this? Probably. OK.

Very common side effects - headache, trembling, dizziness, palpitations,

nausea, dry mouth, constipation...

'They are powerful drugs and in ideal circumstances,

'would only be used short-term.'

They perk you up, they get you through the crisis, the grief,

and then you can come off them and rebuild your life.

That is not the way they're being used with you.

You've been on antidepressants now for eight years.

It's not normal. It's not right.

Well, it is normal, it's completely normal. Yeah, but...

You're like so many other people in Britain,

but I don't think there's any evidence

that these drugs are making you better.

No, I don't either.

'These drugs can help people, but between 2005 and 2012,

'the number of young people prescribed them

'went up by over 50%.'

There is something about giving antidepressants to a 16-year-old

that makes me uneasy.

Not that it should never be done...

..but talking to Sarah, it feels like, you know,

at 16 you're developing, you're learning skills

to cope with problems and this was a time in her life

where she could have been learning that,

and instead she was put into what she describes as a chemical fog.

'I'm on my way to see Sarah at home,

'to find out how I can help her come off the drugs.'

Hi. How are you? Yeah, not bad.

How's it going? Yeah, good. Come in. Come in, it's all right.

I guess one of the reasons to come round is...

..is there are all kinds of clues that you get about someone

from nosing around their house that you can never get,

no matter how long we sit in a doctor's surgery for. Yeah.

If there's anything you're really ashamed of,

that is the thing I most want to see. No.

Go for it, go for it. You lead. You're in charge, Evie. Come on.

Yeah, we're coming up the stairs with you, come on.

Pull the curtains, Evie. Let's do that. Yeah.

You know, it's... It's sort of...

It's diagnostic of low mood, having a room like this,

and if you didn't have a low mood,

then living like this gives you a low mood, cos it's so stressful.

Yeah.

A lot of the clutter belongs to her dead brother, Ben.

Both Ben and her father suffered from depression.

They died within a few years of each other.

My dad was an accidental suicide.

OK. And with my brother...

He was... He got highly addicted to drugs and passed away last year.

Everywhere I look, I see signs

of a woman who's put her life on hold...

..apart from Evie's room.

When she was first born,

and when I found out I was pregnant with her,

that's when I started to feel, like, "Actually, yeah, I can do this,

"because I need to do this.

"I've got somebody that needs me to be strong."

You're going to be the centre of everything, are you?

Sarah doesn't want Evie to see her taking antidepressants

or live with a mum who's depressed.

'And I really want to help her find a way out.'

OK, so what about stuff you used to do, like sport?

Hobbies? I used to love going swimming.

I used to be a good runner.

Yeah, I've kind of really given up on hobbies over the past few years.

When was the last time you went swimming?

Uh... A few weeks back, for her.

When was the last time you did a bunch of lengths?

Years. When was the last time you went out for a run?

Years.

Sarah, I think, is someone who is tough, resilient,

used to love things that are physical, is really social,

so I think a treatment for her is going to encompass all those things.

It's going to be challenging, it's going to be outdoors,

it's going to be physical,

and she's going to do it with some other people.

If this works, I'm hoping she can give up her antidepressants.

'I'm back in Chingford.

'I've come up with a way to try to convince Wendy

'to stop taking her painkillers.'

We've arrived at Wendy's and I've got a little test which,

as far as I'm aware, no-one's ever really done before,

to find out if any of Wendy's painkillers are working.

Maybe they work brilliantly well, maybe I'm totally wrong,

but I've got a way of finding out.

I don't know if Wendy's going to agree, but it's worth a go.

Let's see.

DOG BARKS Jasper.

Hi, Alan. Hello.

Very nice to see you. Hello. Hiya. Nice to see you. How are you?

Yeah, good.

OK, I'll be honest - from everything that you've spoken to me about,

from all your stories, I don't think your painkillers are working,

so I want to do a test to find out if they are working.

OK.

'I've worked out this test with the help of Wendy's doctors.'

These are your pills...

Right. ..for the next two weeks.

OK. Which ones are which?

So, in that blue tablet is a single codeine pill of 15mg, OK?

In each of those red tablets is half a gram of paracetamol.

Right, OK. OK.

There is a twist with these tablets that I've laid out. OK.

Some of these tablets don't contain any medicine.

Right. And you don't know...

OK. ..which ones are real and which ones aren't real.

OK. OK?

But I will know, cos I'll be in pain.

Well, we'll see, won't we? That's the point.

And I'm going to get you to keep a pain chart.

OK? OK. 'Wendy will use this to record her pain levels

'over the next fortnight.

'I want to see if she notices the days when she's taking tablets

'without any drugs.'

But the only way of knowing if these painkillers work for you

is to do this. OK. OK?

That's fine. Are you happy to do this?

Yeah. So, the main thing I need to do now

is take away all your other painkillers.

What about if I have a headache?

If you get a headache, best treatment - big glass of water.

Yes. OK? OK.

Sock drawer.

To make sure she doesn't take more than the prescribed dose,

all the painkillers in the house must go.

Not sure what they are.

Oh, look.

It's been a bit interesting.

I'm sure there's a load of codeine in them things,

so I'll be fine.

Is this it? No. There's some more coming.

There's still upstairs yet.

OK, this is from the upstairs.

Are you sure they're all...? These are all out of your drawer.

No, I think some of them might be my anti-dizziness ones.

Whatever they are, they are all out of your...

They're my Sudafeds.

And remember, this is what you want to do, yeah?

Yeah. Yeah. If the pills are... Just give us 14 days.

Bye, everyone. Bye. See ya. Jasper! Bye, Jasper. Thank you.

Bye, see you.

Toxic side effects in a bag.

Not in a patient. Very pleased.

Found them everywhere.

Found them in the bathroom cabinet, in your make-up thing.

You've got pills everywhere.

I mean, I never knew you were such a pill freak.

You don't need them. We're going to prove that.

'I'm off to Portsmouth.

'I've heard about new research being done there

'that might help Sarah come off her pills, but it's extreme.'

This is the one thing I'm doing with a patient

where I think my colleagues who are psychiatrists

will turn around and go,

"What are you doing? You're a lunatic.

"This is barbaric."

I want to take her swimming in water so cold

that it could kill you from shock.

This is a thing I do.

When I do it, especially when I'm a bit low, my God, it's a pep-up.

But... So then, when I looked into the science more

and I called a mate who supervises this activity regularly, he said,

"No, there's some evidence, there's some evidence it helps

"with anxiety, depression."

So that nailed it.

Before I try this on Sarah,

I'm going to visit my colleague to learn a bit more.

I'm here to see Mike Tipton.

How are you doing? Very nice to see you.

Good to see you, Chris.

'Professor Mike Tipton is a world expert on the effects

'of cold water on the human body.

'He's going to demonstrate why it might be helpful for Sarah.'

Essentially what we're going to do

is demonstrate a cold shock response -

the most dangerous of all responses

associated with immersion in cold water.

If you go through, get changed,

and then we'll get you wired up and ready to go.

You just need to push yourself back with your feet there -

Three, two, one, down.

'Mike's team have discovered that our bodies respond to cold water

'in a similar way to an anxiety attack.'

Well done. That's good. Good effort.

OK, just stick with it.

That's very good. CHRIS GASPS AND SHUDDERS

'As the skin cools down rapidly, the body enters a state of shock,

'flooding the blood with stress hormones.'

There's a sense of severe panic when you first go in.

I thought I was prepared.

It's a big stress response -

one of the biggest stresses you can put the body under.

You can see why we called it the cold shock response -

it's a shocking response in terms of...

It's deeply shocking. Yeah. I'm shocked.

'This chemical surge can leave swimmers feeling euphoric

'once it's passed.'

It is exhilarating.

You're now experiencing what every open-water, wild swimmer says,

"It's just great," because it's...

That skin stimulation releases adrenaline

and all your stress hormones shoot up,

and it is kind of exhilarating... it is kind of exhilarating.

Hiya. You all right?

'But there is another potential benefit for Sarah.

'The evidence shows that repeated exposure to cold water

'conditions the body to deal with the stress response.

'I'm hoping that this conditioning will help her respond better to the

'stresses in her life associated with her anxiety and depression.'

We're going to go to a lake, a man-made lake,

and just give wild swimming a bit of a go.

Sounds good to me. You happy about that?

I'm excited but scared, but...

I know it's going to help, so...

I trust you.

I'm still very nervous now.

I'm slightly nervous about it as well.

'If this works, I think she'll be ready to start coming off her pills,

'but it will be a challenge.'

Here we are. Wow.

It's really, really picturesque, isn't it?

The lake is cold and winter has only just ended.

Sounds good. What do you think? Are you up for this?

I'm up for this. Great, OK. I'm ready. Let's go.

'I've asked Mark and Heather, cold-water swimmers,

'to come and support Sarah.'

Shall we go in up to our shoulders?

No, not yet, just sort your breathing out first.

Look at you. We'll do to the...

OK? Lead me in.

That's all you've got to do, breathe in...

CHRIS GASPS Well done.

That's excellent. You all right? How you doing?

Let's go for a swim.

I'm nearly there.

Sarah, how are you doing? I'm brilliant. How's this?

Amazing. I thought we were just going to do one length.

No. Carry on.

Oh! You all right?

THEY LAUGH 'The therapy seems to be working.'

How do you feel, Sarah? On top of the world.

Yeah? And why do you feel on top of the world?

I've done what I came out to do and I did it well.

I'm blown away, completely.

Mind blown. It's brilliant.

Good. Feel amazing.

Still cold, but...

As well as the euphoric boost,

swimming regularly will give Sarah exercise,

which is recommended as an alternative treatment

for depression by the NHS.

Fantastic. Let's get some cocoa.

It's still a bit odd to me that we did four lengths in there.

Yeah. And if I saw someone jump in now, I'd think, "You're crazy."

"Oh, they need to be rescued!"

Yeah. But no, it was great.

So, over the next four weeks, I'm going to say,

I want you to go swimming six times, OK?

OK. So, not massive.

And the final things, I want you to start tapering your antidepressants.

You've made an appointment to see your GP to do that.

Yeah. I've got an appointment on Thursday. Fine.

I'll keep doing it and keep doing it.

Good. All right.

Let's go home.

'I think Sarah's now ready to be slowly weaned off

'her antidepressants.'

'She's beginning to see that there are other ways

'to treat medical problems than just pills.

'I wonder if that message will get through to Wendy.'

And I must say, all my family had a headache the whole weekend

and they were like, "There was no pills to take."

They were like, "We've got no pills, we've got no pills."

And I was like, "Have a glass of water."

This is where I think there was nothing in them.

Wendy's committed herself to the experiment I devised to see

if her painkillers are really working.

Last night, about 80%, I took the pills.

Today I took some pills and, I must say,

I don't feel any pain at the moment.

She spent two weeks marking a chart I've given her

to record her pain levels.

I woke up this morning about 80%.

My neck is screaming, so I don't think

there was anything in them tablets.

Thank you. I'm sure the tablets I just took in the evening

were placebos, because it's gone up a little bit.

It's day 15, the last day of the trial.

I'm really worried that when Dr Chris comes round

he's going to say I'm just taking them for the sake of taking them.

Hopefully that won't be the case.

'If this proves Wendy's drugs aren't working,

'it means she's been wasting her time and money on them

'for the past 20 years.'

Hello. Who is that? The pizza man?

How are you doing? It's very nice to see you.

I don't normally kiss patients but, OK, you can have a kiss tonight.

Are you going to join all the dots tonight?

We're going to join the dots, all will be revealed.

I've, cautiously, optimistically brought a bottle of wine.

It's very nice to see you. Cheers.

So, um, I guess what I want to know is -

how has it been going the last few days?

Good. Um...

I've not been in a lot of pain.

Have you got your pill box? Yeah.

You've written a little note here, what does it say?

Like, there's nothing in them ones. But the rest of them you thought

there probably was something in them? Yeah. Can I draw the graph?

It's going to be all over the place.

'Before I tell Wendy what's in the pills,

'I want to fill in her pain chart.

'The higher the dot, the more pain she's in.'

It's not easy to join these dots, Wendy,

cos your pain is really variable. Yeah, it is.

So, why don't we draw on this what we've done with your pills?

This should be interesting.

So, the red is your paracetamol.

OK. OK? And that went like this.

We reduced Wendy's dose of paracetamol over the first week,

so she's had no paracetamol at all for ten days.

Oh, my God. I've had no paracetamol.

Since day five. It's been ten days since you had a single gram of

paracetamol. Your pain was quite low on that day, wasn't it,

on day five?

Here's what we've done with your codeine.

OK, you were at 100% of codeine...

We kept Wendy at her full dose of codeine for the first week and then

reduced it gradually,

so she's had no codeine at all for the last five days.

Today, I've had no paracetamol or codeine?

No. None since Friday.

And yesterday you didn't have any,

and the day before that you didn't have any.

You last had a painkiller on Monday morning, you had one codeine.

You are joking.

That was it, that was the last painkiller you had,

so the pills that you have been wolfing...

..the pills that... Oh, my God.

You've had nothing. I've had nothing.

I think what I was really genuinely terrified about is

I would see your pain down here, getting worse

and worse and worse and worse,

and there is no way I can see that on that graph. No.

Give me a hug, I'm so happy. I'm so happy.

It's a perfect demonstration for Wendy

that drugs aren't treating her pain.

The road to salvation with that shoulder

will be in exercising it and strengthening it.

Well, I'm never buying any paracetamol again,

so the kids can go swing for it.

Glass of water.

Thank you. Thank you for doing that.

You've totally...

Have a good weekend. Bye, Jasper. DOG BARKS

Bye. So, it's good, but the battle is only half-won,

because Wendy does have a habit and I don't think it would take all that

much before she went, "You know what?

"Maybe I'll go back and try those naproxen or those Nurofen

"or I might go back to the tramadol."

She'd have another go.

So I have to prove to her, fairly quickly,

that exercise and strength-building is going to fix her pain.

Wendy's attitude to her medications

changed when I proved to her that they weren't working.

He'd need to come in himself to register.

And that's given me an idea that may help cut antibiotic prescriptions

at the surgery.

After all, I failed to show how it can be done

by taking a clinic myself.

In general practice, it's really hard to tell the difference

between a bacterial infection and a viral infection.

Viral infections don't need antibiotics,

but bacterial infections,

if you miss them and you don't prescribe antibiotics,

patients can die, doctors can get sued, it's really bad news.

'And the other difficulty I had was persuading patients

'that they didn't need them.

'Today, I've brought along something to solve both these problems.'

So, this brings the hospital laboratory

to the GP's bedside, the patient's bedside.

'This machine will help me decide

'if they have a bacterial infection or not.' Come in.

'I'm hoping it will help cut the surgery's prescription rates today.'

Hi. You think you need antibiotics?

Yes. OK. Because I've always been told that viruses

should take nine days in and out of your body.

'This machine works by measuring inflammation markers in the blood.

'A result of very 20 means the infection

'is more likely to be bacterial.'

CRP of 65.

I think you might be getting some antibiotics. SHE LAUGHS

'Well, not an ideal start, but at least she needs them.'

Hi. Do you want to come in?

That's quite a gang. Did you want antibiotics?

Yes, of course. OK.

This is a test to see how bad your chest infection is. Yeah.

As well as reassuring worried patients

they're getting the right care,

it will also give doctors peace of mind.

CRP less than five.

Uh-huh. I would say, on the basis of this result,

you will only be harmed by antibiotics.

That's one course of needless antibiotics avoided.

Because what you have to do now is wait.

OK? So, you're just going to get better slowly.

But none of my patients will leave empty-handed.

You can have a book, a DVD, honey, lemon.

That's your prescription.

Thank you very much. Don't eat all that honey at once.

Thanks.

What's your name?

Jake? How old are you? 12.

All right, I am going to give you a prescription today,

you're going to get a lemon.

You're going to get some honey.

And there you go - a James Bond film.

James Bond...one times per day.

Take three days off training.

There's your prescription without antibiotics.

Of the 22 antibiotic prescriptions written out that day,

my machine and I managed to stop two, a reduction of nearly 10%.

If we did that every day of the year,

if we did that across the country,

that is a massive reduction in the number of antibiotics.

So, I guess it's not for me to say the practice should take this up,

but I think...

I think there is room for this.

'I've arranged a meeting with the partners

'to see if they're interested in the machine.'

The machine is somewhere about between ?700 and ?800.

It's ?4.50 a test.

Is this a thing that you think

you'd be interested in?

First of all - there's the cost of the machine and who's paying for it.

There's then also the cost of someone either to run the machine

or the cost of our time doing those tests.

We're never going to be in the position where, at our fingertips,

we have every test that we may wish to have.

'The problem here is the doctors simply don't have

'the time or money to run even simple tests like this.'

If I'm going to make any changes here, it has to be...seamless.

It has to be things that do not take any time.

And it seems trivial, like, "Oh, it's global catastrophe,

"you can do your bit," and they're like, "We're already doing our bit,

"we already prescribe carefully, and, you know, like hell

"we're going to use your machine and run even later than we already are."

Wendy doing her exercises in very limited space

in the bedroom.

It's taken a while to convince Wendy to give up her painkillers.

She's now trying a programme of exercises to strengthen her back,

to see if it will help with the pain.

When I last saw Wendy, I threw away all her drugs that I'd confiscated,

so I hope she hasn't had a wobble.

None of you people are Wendy. Where's Wendy?

There she is. Hi, Wendy. Come on in.

Nice to see you again.

How's the back?

It is better.

I'm not in...

I'm not in pain like I was before.

So, that is what no-one's ever told you

is that exercise is a painkiller, for almost everything,

whether you've got knee pain or hip pain or back pain or neck pain,

even if you've got a headache, exercise is a painkiller.

For me to not take any drugs, I can't actually believe it myself.

I don't even take them for a headache now.

I don't take anything at all.

I feel like I am leaving you in quite a good state.

OK, well, it's our last consultation, have a hug.

Oh, my God. Thank you so much. Aww.

No, no, no, you've totally inspired me,

you've totally inspired me. I really appreciate everything you've done.

You have literally done the hard work.

Thank you so much. Cheers, Wendy. Bye.

It's been an interesting journey.

I'm really, really happy.

I don't take any drugs at all.

I'm exercising every other night.

And I think I'm going to get better.

I think, for 20 years, Wendy took drugs

that totally distracted her and everyone else from

finding the actual cause of the pain.

What an amazing place we've got to with healing and medicine

that we just go, "Take these...take these pills"?!

Wendy is the clearest example of the madness

of the way we do medicine.

I'm beginning to make sense of the madness.

Wendy's now off her drugs and I'm hoping Sarah

will soon start coming off the antidepressants.

I'm more convinced than ever that drug-free treatments

can work better than the pills.

Next, I'm going to supersize my experiment

to take as many patients as possible off drugs.

Keep up, everyone. Come on.

I try to get a group of patients at risk of a heart attack

off their medication.

This is a disaster.

It is.

I take on the pharmaceutical industry...

This is a multi, multi-billion dollar industry.

I don't know how we combat this.

..and I discover just how hard it is to treat people without drugs.

You need to make these swims like doctor's appointments.