0:00:02 > 0:00:03Get your pills. Honest pharmacy.
0:00:03 > 0:00:06We are selling pills with side effects guaranteed.
0:00:06 > 0:00:09'My name is Chris van Tulleken. I'm a doctor.'
0:00:09 > 0:00:11Gastric bleeding, sir?
0:00:11 > 0:00:16'I've been searching for solutions to a medical crisis that affects us all.'
0:00:16 > 0:00:20It can erode your stomach lining and then you bleed from your stomach.
0:00:20 > 0:00:23And it kills a certain number of people every year.
0:00:26 > 0:00:30Every year, doctors hand out over a billion prescriptions.
0:00:30 > 0:00:33That's over 15 courses of medicine for every man,
0:00:33 > 0:00:36woman and child in this country.
0:00:36 > 0:00:38If you've got a headache, take paracetamol.
0:00:38 > 0:00:40If you've got a backache, take co-codamol.
0:00:40 > 0:00:41Aaah.
0:00:41 > 0:00:44Drugs certainly save lives,
0:00:44 > 0:00:46but this binge on medicines is dangerous.
0:00:46 > 0:00:47That is an overdose.
0:00:47 > 0:00:51How could this ever be good for a human being?
0:00:51 > 0:00:53Millions suffer side effects...
0:00:53 > 0:00:56I was waking up depressed.
0:00:56 > 0:00:59..and thousands die every year.
0:00:59 > 0:01:05Overuse of medication is one of the most serious problems that we face.
0:01:05 > 0:01:07I believe there's another way.
0:01:07 > 0:01:12Today is the last day that you are going to take these drugs.
0:01:12 > 0:01:15I've been working at a GP surgery in North East London,
0:01:15 > 0:01:17trying to treat patients without drugs.
0:01:17 > 0:01:21You need to make these swims like doctor's appointments.
0:01:21 > 0:01:23I faced worried doctors...
0:01:23 > 0:01:26Stopping things could be downright dangerous.
0:01:26 > 0:01:27..and sceptical patients.
0:01:27 > 0:01:31To just walk out with nothing, I wouldn't feel safe.
0:01:31 > 0:01:35Now I want to use what I've learned to supersize my experiment
0:01:35 > 0:01:38and get as many patients as I can off drugs.
0:01:38 > 0:01:40SHE GROANS
0:01:40 > 0:01:43I'll take a group of people at risk of a heart attack off their medication.
0:01:43 > 0:01:45So, hand over your drugs.
0:01:47 > 0:01:50But persuading Britain to go cold turkey...
0:01:50 > 0:01:51This is a disaster.
0:01:51 > 0:01:53..could be the hardest thing I've ever done.
0:01:53 > 0:01:56Fix me, please.
0:01:56 > 0:02:00Intensely depressed about how to make it change.
0:02:06 > 0:02:11Churchill Healthcare, Pat speaking. Can I help? I've got the morning.
0:02:11 > 0:02:13Morning's no good, is it?
0:02:13 > 0:02:17Churchill Medical Centre is a busy GP surgery in Chingford,
0:02:17 > 0:02:18North East London.
0:02:18 > 0:02:20- Who's up next?- Tina Hill?
0:02:20 > 0:02:22It looks infected.
0:02:22 > 0:02:25I'm working with the doctors here to try and find ways to reverse
0:02:25 > 0:02:28the steep rise in how often we pop pills.
0:02:28 > 0:02:30- Take care, my love.- Thanks, guys.
0:02:30 > 0:02:32In the 14 years I've been a doctor,
0:02:32 > 0:02:35prescription rates have shot up by over 50%.
0:02:35 > 0:02:37Thank you very much. Cheers.
0:02:37 > 0:02:39Kevin Wingrove?
0:02:39 > 0:02:41Do you want injections?
0:02:41 > 0:02:42Do you want pills?
0:02:42 > 0:02:44Do you want an operation?
0:02:44 > 0:02:48Drugs benefit countless lives, but they can cause side effects,
0:02:48 > 0:02:50from headaches to stomach bleeds,
0:02:50 > 0:02:52and our overuse is now a major public health concern.
0:02:52 > 0:02:54Do you think we could just give you some nice fruit juice?
0:02:54 > 0:02:56Yeah.
0:02:56 > 0:02:59I believe we should be turning to new research that suggests
0:02:59 > 0:03:02many common illnesses are best treated without drugs.
0:03:02 > 0:03:04Clean socks, clean feet...
0:03:04 > 0:03:07- Yep.- ..and keep them warm.
0:03:07 > 0:03:10The doctors here think over-prescription is a problem, too,
0:03:10 > 0:03:14but they're sceptical about how likely I am to make a difference.
0:03:14 > 0:03:16It would be lovely to see if he could do it.
0:03:16 > 0:03:20I don't think it's going to be a walk in the park.
0:03:20 > 0:03:23Nonetheless, I've been encouraged by a few successes.
0:03:23 > 0:03:27Wendy had been using medication for her bad shoulder for 20 years,
0:03:27 > 0:03:29and now she's drug-free.
0:03:29 > 0:03:33For me to not take any drugs, I can't actually believe it myself.
0:03:33 > 0:03:36Oh, my God. Thank you so much.
0:03:36 > 0:03:38No, no, no, you've totally inspired me.
0:03:38 > 0:03:40- You've totally inspired me. - Thanks for everything you've done.
0:03:40 > 0:03:44So far, I've been treating specially selected cases,
0:03:44 > 0:03:48but I want to make a real difference by offering drug-free treatments
0:03:48 > 0:03:51to all 14,000 patients at the practice.
0:03:51 > 0:03:52- Morning.- Good morning.
0:03:52 > 0:03:57Today is the first day I am going to run my drug-free clinic.
0:04:01 > 0:04:04I'm offering patients 30-minute appointments,
0:04:04 > 0:04:0720 minutes longer than they'll get with their GPs.
0:04:07 > 0:04:11The extra time will help me work out what pill-free therapies
0:04:11 > 0:04:12to offer them.
0:04:13 > 0:04:16So I put out my sign for the clinic.
0:04:16 > 0:04:19- Oh, right.- I've got my three waiting seats upstairs,
0:04:19 > 0:04:23so if those seats are full, can you get people to sit out here,
0:04:23 > 0:04:24- you know...?- Cool.
0:04:24 > 0:04:28The public will get the chance to choose me or see their doctors.
0:04:49 > 0:04:53Neither of you are interested in coming to my drug-free clinic?
0:04:53 > 0:04:57- Um, no.- I don't understand how they could prescribe something
0:04:57 > 0:04:59and then not give a prescription. I don't get that.
0:05:05 > 0:05:08So, at the moment, prescriptions are an awful lot more popular
0:05:08 > 0:05:10than my non-prescription clinic.
0:05:10 > 0:05:12Yes.
0:05:12 > 0:05:15Has anyone expressed any interest at all?
0:05:15 > 0:05:17I don't know about out there, but not to me.
0:05:17 > 0:05:20No-one's said anything all morning? And you've been here all morning?
0:05:20 > 0:05:21I have.
0:05:21 > 0:05:23I'm not sure where I'm going wrong.
0:05:25 > 0:05:27Come in.
0:05:27 > 0:05:28Hey, Kam.
0:05:28 > 0:05:31'Dr Kam Seehra is a partner here.'
0:05:31 > 0:05:34So I'm trying to run my drugs-free clinic in the room upstairs
0:05:34 > 0:05:38and it's not working, and I don't know why.
0:05:38 > 0:05:40I think it's because patients, for want of a better word,
0:05:40 > 0:05:42want a quick fix. Society nowadays,
0:05:42 > 0:05:46you just haven't got time to deal with the lifestyle changes.
0:05:46 > 0:05:47Basically, it's about motivation,
0:05:47 > 0:05:52and I think that motivation is going to be your struggle, really.
0:05:52 > 0:05:55For a lot of people it's easier to take that tablet.
0:05:55 > 0:05:58How am I going to deal with this? What can I do?
0:05:58 > 0:06:01You might actually want to target some patients
0:06:01 > 0:06:05who are on painkillers and some of the more common medications,
0:06:05 > 0:06:07perhaps antidepressants.
0:06:07 > 0:06:10Sometimes they're not as effective as the patient might think.
0:06:13 > 0:06:15I've got some ideas on how to motivate patients,
0:06:15 > 0:06:18but first I've got to sign some up.
0:06:21 > 0:06:23So I have some leaflets.
0:06:23 > 0:06:25The No Drugs Clinic.
0:06:25 > 0:06:27For an appointment, it's room nine.
0:06:27 > 0:06:29- Perfect.- Good. All right. - No problem.
0:06:31 > 0:06:34The receptionists have agreed to do some marketing for me,
0:06:34 > 0:06:37to find the kinds of patients Kam's suggesting.
0:06:37 > 0:06:39Cheers, guys.
0:06:42 > 0:06:45For the last three weeks, I've been working with someone
0:06:45 > 0:06:48who's taking a drug I've been recommended to target.
0:06:50 > 0:06:53Antidepressants do help some people,
0:06:53 > 0:06:57but 24-year-old Sarah has been taking hers for eight years.
0:06:57 > 0:06:59I need my eyeballs by the end of it.
0:07:00 > 0:07:03After I introduced her to cold water swimming,
0:07:03 > 0:07:06Sarah decided to give it a try in place of her pills.
0:07:07 > 0:07:11- How do you feel, Sarah? - On top of the world.
0:07:11 > 0:07:13THEY LAUGH
0:07:13 > 0:07:16Research carried out at the University of Portsmouth suggests
0:07:16 > 0:07:21that swimming in cold water could help treat anxiety and depression.
0:07:21 > 0:07:23When was the last time you felt this good?
0:07:23 > 0:07:26- When my little girl was born. - Really?- Yeah, really.
0:07:29 > 0:07:32But before she starts to come off her drugs,
0:07:32 > 0:07:36I want Sarah to be benefitting from swimming outdoors regularly.
0:07:41 > 0:07:44It's the weekend and it's two weeks since we swam together.
0:07:44 > 0:07:47- Hey, Sarah. - Hiya.
0:07:47 > 0:07:49How are you feeling today?
0:07:49 > 0:07:51Erm... Pretty rubbish at the moment.
0:07:51 > 0:07:54Yeah, I mean, you look almost tearful, if I'm honest.
0:07:54 > 0:07:56- No, you can't see.- No?
0:07:56 > 0:07:58I'm not tearful.
0:07:58 > 0:08:02Yeah, unfortunately, the resolution is really good and I can see
0:08:02 > 0:08:04your eyes filling with tears.
0:08:06 > 0:08:08I'm only laughing because you are.
0:08:08 > 0:08:10So how's the last week been?
0:08:10 > 0:08:14Well, unable to get any sort of childcare, so I haven't been able
0:08:14 > 0:08:16to go swimming, which I'm quite upset about.
0:08:16 > 0:08:19I seem to have had a bit of a come-down.
0:08:19 > 0:08:22It's hard this, isn't it? Because, to put this
0:08:22 > 0:08:25in the starkest medical terms,
0:08:25 > 0:08:29you have a medical problem for which you need to go and have treatment,
0:08:29 > 0:08:33and if you were going for chemotherapy,
0:08:33 > 0:08:37if you were going for an operation, everyone would give you childcare.
0:08:37 > 0:08:39I think this is no less important.
0:08:39 > 0:08:42So, yeah, why could you not have gone today?
0:08:42 > 0:08:45Today? I don't want to today.
0:08:45 > 0:08:47Yeah, that's the biggest reason - I don't want to today.
0:08:48 > 0:08:50Yeah.
0:08:50 > 0:08:52I'm miserable.
0:08:52 > 0:08:53I'm fed-up.
0:08:55 > 0:08:56Yeah.
0:08:56 > 0:08:58So, you've lost a bit of momentum?
0:09:00 > 0:09:01Yeah.
0:09:01 > 0:09:03Today, yeah.
0:09:03 > 0:09:07What you're describing is the thing that screws us all up.
0:09:07 > 0:09:09This is kind of the anatomy of failure.
0:09:09 > 0:09:14We fail one tiny, tiny, tiny bit at a time,
0:09:14 > 0:09:17and we miss it one week and then it's easier to miss it
0:09:17 > 0:09:19the next week, then it's easier to miss it the next week.
0:09:19 > 0:09:24But you need to make these swims like doctor's appointments, OK?
0:09:24 > 0:09:26- It's just been a bad week. - All right, all right.
0:09:26 > 0:09:28I'll speak to you later then.
0:09:28 > 0:09:31OK. All right. Bye.
0:09:32 > 0:09:33Oh, I feel naive.
0:09:33 > 0:09:34I just feel like, "Oh, God."
0:09:34 > 0:09:37You know, I just thought we could dunk her in cold water
0:09:37 > 0:09:39and she'd feel better.
0:09:39 > 0:09:42I'm hoping the pep talk will get her swimming,
0:09:42 > 0:09:44but I'm beginning to doubt my approach.
0:09:53 > 0:09:56But there's good news back at the surgery -
0:09:56 > 0:09:59after hundreds of phone calls, I'm starting to get interest
0:09:59 > 0:10:01in my no-drug clinic.
0:10:02 > 0:10:05Crystal. Come on in.
0:10:05 > 0:10:06- Do you want a hand? - Please.
0:10:09 > 0:10:12What do you want to get...? I'll get the handbag, I'll get the bags.
0:10:12 > 0:10:15Tell me what the issue is.
0:10:15 > 0:10:18I'm in pain every day, just kind of varying degrees.
0:10:18 > 0:10:21I've got it going up my neck.
0:10:21 > 0:10:24I get a lot of pain down my right side.
0:10:24 > 0:10:26I mean, you're obviously in a lot of pain now,
0:10:26 > 0:10:28sitting here talking to me.
0:10:28 > 0:10:31I'm actually... This is a good day.
0:10:31 > 0:10:33What do you want, in the broadest possible way?
0:10:33 > 0:10:35I just want to be normal.
0:10:35 > 0:10:40I just want to work and live, rather than feel like I'm existing.
0:10:46 > 0:10:51Crystal is 36, and she's been like this for three years.
0:10:51 > 0:10:55Long-term, or chronic, pain is surprisingly common.
0:10:55 > 0:10:5814 million people in the UK suffer from some form of it.
0:11:00 > 0:11:02But Crystal's case is extreme,
0:11:02 > 0:11:05and her doctors don't know what to do with her.
0:11:06 > 0:11:09So there's nothing that anyone has been able to find,
0:11:09 > 0:11:13specialists or GPs, that explains why she's having
0:11:13 > 0:11:16all this really severe pain?
0:11:16 > 0:11:17In a nutshell, no,
0:11:17 > 0:11:21and it's difficult to manage if you don't know where it's coming from.
0:11:21 > 0:11:25'Doctor Nausheen Hameed is overseeing Crystal's care.
0:11:25 > 0:11:28'Physiotherapy hasn't worked and they're relying on
0:11:28 > 0:11:30'powerful painkillers to help her.'
0:11:30 > 0:11:33Left to general practice, what would happen?
0:11:33 > 0:11:38It would continue to cycle between a referral here, a referral there,
0:11:38 > 0:11:42back to us for repeat prescriptions the next five, ten years.
0:11:42 > 0:11:44And that's sad, actually.
0:11:44 > 0:11:48- Nausheen, thanks very much. - You're welcome.- I will go and try
0:11:48 > 0:11:51- and find some way of doing this without drugs.- Well, good luck.
0:11:51 > 0:11:53All the best. Bye.
0:11:53 > 0:11:55- I'll keep you informed. - Thank you.
0:11:57 > 0:12:01Trying to get her off the medications is an amazing idea,
0:12:01 > 0:12:04but I think it's going to be a struggle.
0:12:04 > 0:12:07She's been on them for such a long time and, you know,
0:12:07 > 0:12:11they are controlling her pain to some extent, and I just worry that,
0:12:11 > 0:12:14you know, how is she going to cope without them?
0:12:19 > 0:12:22It's estimated that millions of people live with pain
0:12:22 > 0:12:24that has no apparent cause,
0:12:24 > 0:12:28but for patients like Crystal, the suffering is very real.
0:12:28 > 0:12:32I am not an expert in chronic pain, so I want to find out
0:12:32 > 0:12:35what is it like to try and live at home in that amount of pain?
0:12:44 > 0:12:45Hello?
0:12:45 > 0:12:47Hi, Crystal, it's Chris.
0:12:49 > 0:12:51Here we are.
0:12:51 > 0:12:53Smiling but moving slow.
0:12:53 > 0:12:57- Sorry.- Don't be sorry. How you doing?- At the moment, not too bad.
0:12:57 > 0:13:01But I have been known to come up here on my bottom.
0:13:01 > 0:13:02Not dignified or comfortable.
0:13:02 > 0:13:04No. None of this is dignified.
0:13:11 > 0:13:13And this is what I do.
0:13:13 > 0:13:17But I can't stay in that position for too long
0:13:17 > 0:13:18because my neck starts to hurt.
0:13:22 > 0:13:26I'm sorry, I took some meds a little while ago, so now I'm starting to...
0:13:26 > 0:13:27You're a little bit slow...
0:13:27 > 0:13:30- Foggy.- ..and a little bit foggy, yeah.
0:13:30 > 0:13:32Don't worry. Give me the tour.
0:13:32 > 0:13:34You've got a feature wall.
0:13:34 > 0:13:38Of course. Changing Rooms - it was my programme in the day.
0:13:41 > 0:13:44Crystal lives here with her teenage son.
0:13:44 > 0:13:48I was in the gym when I was first made aware that there was something
0:13:48 > 0:13:53wrong with my back. I was training for a 10k run...
0:13:53 > 0:13:55Cancer Research.
0:13:55 > 0:13:59They basically could hear my back, it was that loud, and came over
0:13:59 > 0:14:02and said, "Look, you need to go and get that checked out."
0:14:02 > 0:14:05And then, within a short space of time,
0:14:05 > 0:14:12I just couldn't move or anything without screaming out in pain.
0:14:12 > 0:14:15Crystal now spends most of her time trapped in this flat.
0:14:15 > 0:14:18She can't work and she's only able to get out
0:14:18 > 0:14:20after elaborate preparation.
0:14:20 > 0:14:22This is my corset.
0:14:22 > 0:14:26It just stops my back, or rather my tail bone,
0:14:26 > 0:14:30from feeling like it's going to pop right through the skin.
0:14:31 > 0:14:34And she doesn't go anywhere without her neck brace.
0:14:40 > 0:14:44Today we're off to pick up her month's supply of painkillers.
0:14:45 > 0:14:48What's so bad about the bus?
0:14:48 > 0:14:51Right now, exactly what he's doing, just braking -
0:14:51 > 0:14:52all of that I can feel.
0:14:52 > 0:14:55Just bloody painful.
0:14:58 > 0:15:00Hopefully they won't have run out.
0:15:00 > 0:15:01- No.- So, is this it?
0:15:01 > 0:15:04It is today. I normally have two.
0:15:04 > 0:15:06- Normally you have two? It's heavy.- Thank you.
0:15:06 > 0:15:08Take care. See you later.
0:15:09 > 0:15:13I'm amazed at just how many drugs Crystal's picked up,
0:15:13 > 0:15:15and I'm worried what it's doing to her.
0:15:17 > 0:15:19Spread the drugs out.
0:15:19 > 0:15:21That's the heaviest bit of shopping.
0:15:22 > 0:15:26- So I have my codeine... - OK.- ..which is a pain reliever.
0:15:26 > 0:15:29I take four of those four times a day.
0:15:29 > 0:15:32So, you're taking 16 of these per day?
0:15:32 > 0:15:35- Yes. - That's a huge dose.
0:15:35 > 0:15:39'Codeine is related to morphine and heroin, and it can be addictive.'
0:15:39 > 0:15:44This one is the tramadol, and I'm taking that three times a day.
0:15:44 > 0:15:46OK. So that's a stronger version of codeine.
0:15:46 > 0:15:48A stronger version of the codeine,
0:15:48 > 0:15:52and I take those, basically, together.
0:15:52 > 0:15:54'These drugs are called opioids.
0:15:54 > 0:15:57'They're similar to pain-reducing chemicals produced by our bodies
0:15:57 > 0:16:01'called endorphins. They cause side effects like constipation
0:16:01 > 0:16:06'and nausea, and Crystal has to take even more drugs to deal with those.'
0:16:06 > 0:16:10If I was taking all of this and I felt pain-free
0:16:10 > 0:16:14then I would at least feel like I was achieving something
0:16:14 > 0:16:17by taking this amount of medication, but I'm still not pain-free.
0:16:17 > 0:16:21I don't get why you're taking these pills. I'm not sure you get why you're taking the pills,
0:16:21 > 0:16:23but is it just because there is nothing else to do?
0:16:23 > 0:16:27Seriously, yeah. Yes, is the short of it.
0:16:27 > 0:16:29I'm pretty sure the answer doesn't lie in those pills,
0:16:29 > 0:16:33but rather in exercise and physical therapy but, at the moment,
0:16:33 > 0:16:35Crystal's so immobile
0:16:35 > 0:16:38I'm not sure if she'll be able to do anything at all.
0:16:38 > 0:16:41I feel positive because I think
0:16:41 > 0:16:45Crystal is at least willing to try and do the hard work,
0:16:45 > 0:16:48but I don't think she's got a clue about how hard this is going to be.
0:16:55 > 0:16:57I need a swimming bag.
0:16:57 > 0:17:00A swimming bag would be a good idea.
0:17:00 > 0:17:02It's been a week since I spoke to Sarah,
0:17:02 > 0:17:05and she's responded well to my pep talk.
0:17:07 > 0:17:11Today she's going cold water swimming again with her partner
0:17:11 > 0:17:12at a nearby lake.
0:17:12 > 0:17:14I want that feeling back.
0:17:14 > 0:17:18It just gets on top of you when you suffer with depression.
0:17:18 > 0:17:22Everything builds up and you do need a stress relief,
0:17:22 > 0:17:24and antidepressants don't do that.
0:17:25 > 0:17:29A bracing swim in 13-degree water will hopefully do the trick.
0:17:35 > 0:17:36Do I look attractive?
0:17:38 > 0:17:41It's the first time she's been in cold water since I took her swimming
0:17:41 > 0:17:44in Portsmouth over a fortnight ago.
0:17:44 > 0:17:46How is it, Sarah?
0:17:46 > 0:17:47Actually quite nice.
0:17:47 > 0:17:52A lot nicer than Portsmouth, but still quite chill.
0:17:54 > 0:17:57I'll be back. I'm going to go swimming. See you in a bit.
0:17:59 > 0:18:02Exposing the body to the shock of cold water can leave people
0:18:02 > 0:18:06feeling euphoric. Some scientists think it may even condition them
0:18:06 > 0:18:10to help deal with other stresses in their lives.
0:18:10 > 0:18:12But Sarah doesn't stay in very long.
0:18:16 > 0:18:18I can't breathe.
0:18:26 > 0:18:29I started looking at the water and I started feeling like I wasn't
0:18:29 > 0:18:33moving anywhere. It was horrible. I thought I was going to drown.
0:18:38 > 0:18:40Tell me what happened.
0:18:40 > 0:18:46I swam out quite far on my own, and then I think I had nobody with me,
0:18:46 > 0:18:50so I started to panic, thought I was going to drown,
0:18:50 > 0:18:52freaked out and swam back.
0:18:52 > 0:18:53What can we do next?
0:18:53 > 0:18:58How can we make this so it isn't terrifying every time?
0:18:58 > 0:19:02I think I found when I was in Portsmouth that swimming with somebody helped.
0:19:02 > 0:19:04- Right.- So...
0:19:05 > 0:19:07Yeah, probably that would help.
0:19:08 > 0:19:11All right, we will figure something out and I will get back to you, all right?
0:19:13 > 0:19:16Sarah needs to just have someone to hold her hand in the way
0:19:16 > 0:19:20that doctors, nurses and pharmacists do when you start a course
0:19:20 > 0:19:22of prescription medication.
0:19:22 > 0:19:25Down another inch. Good stuff.
0:19:25 > 0:19:28I've decided to get Sarah a swimming coach to support her.
0:19:31 > 0:19:34She's been on antidepressants since she was a teenager,
0:19:34 > 0:19:36and coming off them can be hard.
0:19:39 > 0:19:42Between 2005 and 2012,
0:19:42 > 0:19:46the number of young people prescribed these drugs shot up
0:19:46 > 0:19:51by 54%. For many, the first step is filling out a simple form.
0:19:53 > 0:19:57So I have here the PHQ-9 depression questionnaire,
0:19:57 > 0:20:01and this is one of the most common tools that GPs use in the UK
0:20:01 > 0:20:05and all around the world, so I'm going to see if I am depressed.
0:20:05 > 0:20:07So, the questionnaire.
0:20:07 > 0:20:08"Over the last two weeks,
0:20:08 > 0:20:14"how often have you been bothered by any of the following problems?"
0:20:14 > 0:20:17Problem one. "Little interest or pleasure in doing things."
0:20:17 > 0:20:21So, for several days, I have definitely had little interest
0:20:21 > 0:20:23or pleasure in doing things.
0:20:23 > 0:20:26Number two. "How often over the last two weeks have you felt down,
0:20:26 > 0:20:28"depressed or hopeless?"
0:20:28 > 0:20:32I haven't felt hopeless at any point in the last couple of weeks,
0:20:32 > 0:20:36but I have felt down or depressed.
0:20:36 > 0:20:39Some doctors use this test to help them prescribe
0:20:39 > 0:20:41and monitor antidepressants.
0:20:41 > 0:20:44"How often have you been bothered by poor appetite or overeating?"
0:20:44 > 0:20:46I mean, I just perpetually overeat.
0:20:46 > 0:20:51But it's also on the NHS website, allowing anyone to test themselves.
0:20:51 > 0:20:52And then we add up the score.
0:20:54 > 0:20:57"Based on your responses today, it's very likely
0:20:57 > 0:21:00"you could be suffering from some form of depression,
0:21:00 > 0:21:04"but only an experienced health professional can tell for sure."
0:21:04 > 0:21:06So, according to this, I have moderate depression,
0:21:06 > 0:21:10and I'll tell you, I do NOT have moderate depression.
0:21:10 > 0:21:13The striking thing about this is that there is not
0:21:13 > 0:21:15a single positive question on it.
0:21:15 > 0:21:17Ask me some other questions.
0:21:17 > 0:21:21Ask, "How often have you felt happy and positive about your life,
0:21:21 > 0:21:24"every single day?"
0:21:24 > 0:21:28This is a questionnaire that does its best to force you to think
0:21:28 > 0:21:32about how miserable your life is and how unhappy you are.
0:21:32 > 0:21:36This is a questionnaire that was developed by a drugs company,
0:21:36 > 0:21:39by a drugs company who make drugs that treat depression.
0:21:42 > 0:21:45This isn't the first time I've noticed the influence
0:21:45 > 0:21:47of pharmaceutical companies.
0:21:48 > 0:21:51Just looking around the office...
0:21:51 > 0:21:53Pneumovax II.
0:21:56 > 0:21:58We've got a little duck here - Sanofi-Aventis, drug company.
0:21:58 > 0:22:02You know, that just reminds you that you can use that flu vaccine.
0:22:03 > 0:22:05Sponsored by GlaxoSmithKline.
0:22:05 > 0:22:08Yeah, this is a model of the female genital tract.
0:22:08 > 0:22:10You show the model to patients,
0:22:10 > 0:22:13and all the while there's a little branding there reminding you.
0:22:17 > 0:22:22It's just having the marketing here prompts people
0:22:22 > 0:22:24to prescribe those brands more.
0:22:24 > 0:22:27It's just sort of the hidden hand of the pharmaceutical industry
0:22:27 > 0:22:28in the office.
0:22:30 > 0:22:32And the marketing doesn't stop there.
0:22:35 > 0:22:36Clinical meeting.
0:22:36 > 0:22:39I'm on my way to a meeting the GPs are having
0:22:39 > 0:22:40at another surgery nearby.
0:22:43 > 0:22:46There's a lunch to go with the meeting, and the lunch is,
0:22:46 > 0:22:51we've heard, sponsored and paid for by a drug company.
0:22:51 > 0:22:53And this is completely normal, OK?
0:22:53 > 0:22:54This happens in hospitals,
0:22:54 > 0:22:57in general practices all over the country every day,
0:22:57 > 0:23:01and my honest opinion is it is a total, total disgrace,
0:23:01 > 0:23:03and it's the only thing
0:23:03 > 0:23:08that I've yet heard about with this practice that makes me...
0:23:08 > 0:23:10kind of wince.
0:23:10 > 0:23:12It's a bribe.
0:23:12 > 0:23:13It's a simple bribe.
0:23:14 > 0:23:16The drug reps provide the food,
0:23:16 > 0:23:19and in return they get an opportunity to talk up
0:23:19 > 0:23:21their latest products.
0:23:21 > 0:23:25- Where's lunch happening? - It's the second floor.
0:23:25 > 0:23:27'These lunches are a regular event.'
0:23:27 > 0:23:29Is it a good selection of sandwiches, normally?
0:23:29 > 0:23:31- Yeah.- Indian last week.
0:23:31 > 0:23:36On the menu today, a selection of upmarket salads and sandwiches.
0:23:36 > 0:23:40I want to know more, but the drug company rep has a word with the GPs.
0:23:40 > 0:23:43- Sorry, just while the drug reps are here.- Oh, you can't be called...
0:23:43 > 0:23:47You can be in here but we can't be called while drug reps in here.
0:23:47 > 0:23:51The rep gives his talk and, ten minutes later, he leaves.
0:23:51 > 0:23:54Why do you have drug reps come at the beginning
0:23:54 > 0:23:55of the clinical meeting?
0:23:55 > 0:23:58- Be honest? - Completely honest, yeah.
0:23:58 > 0:24:01Have you just finished the truth, is that...?
0:24:01 > 0:24:04I'm about 90% of the way through the truth.
0:24:04 > 0:24:06Yeah, I'm eating the evidence.
0:24:06 > 0:24:10I mean, what they hope is it affects our prescribing data and the drugs
0:24:10 > 0:24:14they prescribe, and every doctor you speak to will tell you categorically
0:24:14 > 0:24:16it doesn't affect it.
0:24:16 > 0:24:18The practice use the free lunch to get together
0:24:18 > 0:24:20and talk shop, but, in fact,
0:24:20 > 0:24:24recent research shows that doctors are more likely to prescribe
0:24:24 > 0:24:27certain drugs if they take meals from drug reps.
0:24:29 > 0:24:32So I went in there and I swore that I wouldn't eat any of the food,
0:24:32 > 0:24:36and then midway through the meeting I realised that I had started
0:24:36 > 0:24:39to eat a tangerine.
0:24:39 > 0:24:40We know it influences prescribing,
0:24:40 > 0:24:43the drug companies know it influences prescribing.
0:24:43 > 0:24:46This is a multi-multi-billion dollar industry
0:24:46 > 0:24:53with deep pockets and huge focus, and I don't know how we combat this.
0:24:53 > 0:24:56First I'll try to get an explanation from the drug company rep
0:24:56 > 0:24:58supplying the lunches.
0:24:58 > 0:25:02Chris van Tulleken here. I just wanted to give you a ring
0:25:02 > 0:25:06to see if you'd be willing to have a chat with us on camera.
0:25:06 > 0:25:10Thanks very much indeed, and we'll speak soon. I'll bung you over an e-mail this afternoon.
0:25:10 > 0:25:12All right. Cheers, bye.
0:25:12 > 0:25:15He does seem like a really nice bloke.
0:25:15 > 0:25:19In principle, if the communications team at his drugs company
0:25:19 > 0:25:22are willing for us to speak to him, he's willing to speak to us.
0:25:22 > 0:25:24That should be nice, ask him some questions.
0:25:24 > 0:25:25So I'll write him an e-mail now.
0:25:27 > 0:25:28I'll wait for him to get back to me.
0:25:30 > 0:25:32Meanwhile, I've got an important appointment with
0:25:32 > 0:25:34chronic pain sufferer Crystal.
0:25:36 > 0:25:39So, we're going to see a physio
0:25:39 > 0:25:42who is a really, really good physio.
0:25:42 > 0:25:43OK.
0:25:43 > 0:25:46Because I want him to...
0:25:46 > 0:25:49assess you, because he works with a lot of people like you
0:25:49 > 0:25:50who have chronic pain.
0:25:52 > 0:25:54Have you got any questions?
0:25:54 > 0:25:58No, not really, just can we get there quicker?
0:25:58 > 0:25:59I'm not knocking your suspension!
0:25:59 > 0:26:01THEY LAUGH
0:26:03 > 0:26:07Getting appointments with NHS physiotherapists can take months,
0:26:07 > 0:26:09so I've had to go private.
0:26:09 > 0:26:12- Hi. Rob Madden, pleased to meet you. How are you?- Nice to meet you.
0:26:12 > 0:26:14- Would you like to come down?- Yep.
0:26:15 > 0:26:18Bend your knee up towards you again, slowly.
0:26:18 > 0:26:20Yeah, it's hurting.
0:26:20 > 0:26:24Crystal's previous attempts at physiotherapy have failed, but
0:26:24 > 0:26:27I hope this assessment will give me clues on the best way to treat her.
0:26:27 > 0:26:29Oh, my God, OK.
0:26:29 > 0:26:31Now I've got upper body pain, too.
0:26:31 > 0:26:33OK. You are doing absolutely fine.
0:26:34 > 0:26:37This is how I get up out of bed.
0:26:37 > 0:26:40Chronic pain can be caused by a range of things,
0:26:40 > 0:26:43from damaged nerves to joint problems.
0:26:43 > 0:26:47Even the way the person perceives the pain can play a role.
0:26:47 > 0:26:49But Crystal's pain is worse because she's stopped moving
0:26:49 > 0:26:51and has grown weak.
0:26:51 > 0:26:52Oh, Jesus.
0:26:55 > 0:26:56You OK?
0:26:56 > 0:26:59I need to find a way to build up her strength.
0:27:01 > 0:27:02So what do you think?
0:27:02 > 0:27:05My outright concern is, at the moment,
0:27:05 > 0:27:10if you take her off her medications and ask her to do more physically,
0:27:10 > 0:27:12then there's a high chance that she could have a bit of a flare-up,
0:27:12 > 0:27:15so all of her back pain could actually get worse.
0:27:15 > 0:27:18My gut instinct is that she will struggle without medication.
0:27:18 > 0:27:21So it's not just that my
0:27:21 > 0:27:25plan might fail, it's that I might make her much worse.
0:27:25 > 0:27:28That could happen. We need to take small steps.
0:27:32 > 0:27:34Rob wants me to get a second opinion.
0:27:37 > 0:27:41I still believe Crystal can get off these drugs.
0:27:43 > 0:27:45I do, I think her problems...
0:27:45 > 0:27:47A huge amount of her problems are caused by drugs.
0:27:49 > 0:27:52This used to be called black gas.
0:27:52 > 0:27:55I'm meeting Dr Cathy Stannard at an exhibition containing some of
0:27:55 > 0:27:58the earliest forms of pain management.
0:27:58 > 0:28:02"Oxford Vaporiser. Portable self-contained ether vaporiser
0:28:02 > 0:28:03"for use in battle conditions."
0:28:05 > 0:28:09Dr Stannard is one of the country's top consultants specialising
0:28:09 > 0:28:10in chronic pain.
0:28:10 > 0:28:12What do you think in general?
0:28:12 > 0:28:15Your totally honest, blunt opinion about what I'm trying to do,
0:28:15 > 0:28:18about my attempt at a drugs-free clinic.
0:28:18 > 0:28:20Well, actually, in evidence terms, it's really sensible.
0:28:20 > 0:28:23- Really?- Certainly in pain, that makes sense.
0:28:23 > 0:28:25We know that medications aren't the answer.
0:28:25 > 0:28:28There is no evidence for effectiveness of opioids
0:28:28 > 0:28:32- in the long term.- There's no evidence that they work at all?
0:28:32 > 0:28:35There's no evidence. Even with somebody with long-term pain,
0:28:35 > 0:28:39if you start off they may well work for four to six weeks,
0:28:39 > 0:28:41and after that they will stop working.
0:28:41 > 0:28:43What proportion of people are harmed?
0:28:43 > 0:28:46Cos you're saying we're giving out more and more of these kind of drugs
0:28:46 > 0:28:49- in this country.- I think it's difficult to put a figure on.
0:28:49 > 0:28:53What we know for sure is that about 80% of people taking a drug,
0:28:53 > 0:28:56taking an opioid, will have at least one adverse effect.
0:28:56 > 0:28:59But we also know is that there are some more serious harms that are
0:28:59 > 0:29:04associated with high doses over longer periods, so, for example,
0:29:04 > 0:29:08disruption of hormones, changes in the immune system.
0:29:10 > 0:29:11Really?
0:29:11 > 0:29:13With long-term exposure,
0:29:13 > 0:29:16the drugs can actually make pain worse rather than better.
0:29:21 > 0:29:22Hi, Crystal, it's Chris.
0:29:25 > 0:29:29Dr Stannard agrees Crystal should try and come off the drugs
0:29:29 > 0:29:32if she feels able. She and crystal's GP have made a programme
0:29:32 > 0:29:34to wean her off them safely.
0:29:34 > 0:29:39Today is the last day that you are going to take these drugs...
0:29:39 > 0:29:43- OK.- ..in the way that you've been taking them.
0:29:43 > 0:29:44'This won't be easy.
0:29:44 > 0:29:48'Cutting down means that Crystal may have unpleasant withdrawal effects.'
0:29:48 > 0:29:50The tramadol and the codeine -
0:29:50 > 0:29:54they're addictive in the same way that heroin is...
0:29:54 > 0:29:57- Yeah.- ..that morphine is, so we need to taper these off
0:29:57 > 0:30:00so that coming off them isn't worse than staying on them.
0:30:00 > 0:30:03So phase one is tapering, but we're not just going to do that,
0:30:03 > 0:30:06we want to actually try and fix you as well.
0:30:08 > 0:30:10Over the next few weeks, her doses of drugs
0:30:10 > 0:30:12will get smaller and smaller.
0:30:15 > 0:30:19- Cheers, Crystal.- Take care.- I'll see you soon.- Thank you.- Bye.- Bye.
0:30:19 > 0:30:23I'm also going to have to find a long-term solution that really works
0:30:23 > 0:30:24to take the place of the drugs.
0:30:26 > 0:30:30But first I'm turning my attention back to putting a stop to
0:30:30 > 0:30:33the lunches at the surgery paid for by the pharmaceutical industry.
0:30:33 > 0:30:36You might think I'm getting a bit worked up about a few sandwiches
0:30:36 > 0:30:38given out at a GP's practice in Chingford
0:30:38 > 0:30:40by a pharmaceutical industry rep.
0:30:40 > 0:30:42Not a big deal. Small beer.
0:30:42 > 0:30:44Let me show you why I'm getting worked up.
0:30:44 > 0:30:46OK.
0:30:46 > 0:30:48Over the last few years, OK,
0:30:48 > 0:30:51the drugs industry has paid 13 billion in fines
0:30:51 > 0:30:53in the US alone.
0:30:54 > 0:30:57The fines are for a range of unethical activities,
0:30:57 > 0:31:00including bribing doctors to prescribe their drugs.
0:31:02 > 0:31:05While the lunches drug companies buy are perfectly legal,
0:31:05 > 0:31:10I'm uncomfortable with them having such direct access to our doctors.
0:31:10 > 0:31:13We get amazing drugs from them, but anyone who thinks
0:31:13 > 0:31:17that a representative from a drugs company is going to give
0:31:17 > 0:31:21totally independent, unbiased information about their product
0:31:21 > 0:31:24is, frankly, insane.
0:31:26 > 0:31:30The drugs rep has been told not to speak to me,
0:31:30 > 0:31:34so I've come to the Association of the British Pharmaceutical Industry,
0:31:34 > 0:31:36a body that represents drug companies in the UK,
0:31:36 > 0:31:39to speak to Dr Virginia Acha.
0:31:39 > 0:31:43We have filmed an awful lot of pizzas and sandwiches
0:31:43 > 0:31:46and soft drinks and apples and packets of crisps
0:31:46 > 0:31:49that are given out by pharmaceutical industry reps,
0:31:49 > 0:31:51and that really concerns me.
0:31:51 > 0:31:54OK, and it should. So we do have a code of practice,
0:31:54 > 0:31:57so if their was evidence being presented there, it should be
0:31:57 > 0:31:59proper scientific evidence.
0:31:59 > 0:32:05So you're comfortable with your NHS GP being educated by someone
0:32:05 > 0:32:08who is employed directly by an industry that is selling drugs?
0:32:08 > 0:32:12I would be concerned if my GP was not aware of all the different
0:32:12 > 0:32:14treatment developments that were happening,
0:32:14 > 0:32:17but what's interesting to me is the people who really get informed
0:32:17 > 0:32:20at those meetings are the very same company representatives,
0:32:20 > 0:32:22because they're hearing questions
0:32:22 > 0:32:26that perhaps were not thought through when the company was putting
0:32:26 > 0:32:28together whatever material needed to support it,
0:32:28 > 0:32:32or there's an insight about how care could be better delivered.
0:32:32 > 0:32:35If we don't have that feedback from the doctors about the quality
0:32:35 > 0:32:39and impact of a medicine, there's no signal to the system to have a look
0:32:39 > 0:32:41at a medicine and consider,
0:32:41 > 0:32:44"Is there something here that we should be looking at?"
0:32:44 > 0:32:45Thank you so much.
0:32:45 > 0:32:50I accept we cannot develop new drugs without
0:32:50 > 0:32:54industry coming into contact with doctors and patients,
0:32:54 > 0:32:56but they're still influencing prescribing.
0:32:56 > 0:32:59Buying doctors sandwiches - it's not good.
0:32:59 > 0:33:02And even a sandwich changing hands, I think...
0:33:04 > 0:33:05I think we can avoid that.
0:33:05 > 0:33:07I think we can just get rid of the sandwiches.
0:33:09 > 0:33:13But the only way I can make that happen at Churchill is by persuading
0:33:13 > 0:33:15the partners to stop taking the lunches.
0:33:19 > 0:33:21I'm really amazed, I guess,
0:33:21 > 0:33:25that you have drugs company-sponsored lunches.
0:33:25 > 0:33:30- Why?- I guess maybe it feels like we're at a point in medicine
0:33:30 > 0:33:34where we know it's bad, and it doesn't square with anything else
0:33:34 > 0:33:36that I've seen in this practice.
0:33:36 > 0:33:39I mean, If I take you back to when we first met you, you know,
0:33:39 > 0:33:42you wanted to get everyone together, so what did you do?
0:33:42 > 0:33:43I bought you all sandwiches.
0:33:43 > 0:33:46Absolutely, because if there's one way you can get people together
0:33:46 > 0:33:48it's provide something that makes it worth their coming.
0:33:48 > 0:33:52Well, maybe I'm no better, but to turn that on its head,
0:33:52 > 0:33:55the person who should be criticised here is you
0:33:55 > 0:33:58for accepting my sandwiches, because it is a bribe.
0:33:58 > 0:34:02When I first started, I had an offer of a conference in a ski resort
0:34:02 > 0:34:05that was basically a ski holiday. So, we've gone from there
0:34:05 > 0:34:08- to once a month having a couple of sandwiches.- OK.
0:34:08 > 0:34:11We're constantly sent leaflets and invites to evening meetings
0:34:11 > 0:34:14at very nice restaurants.
0:34:14 > 0:34:16'The doctors only take the lunches,
0:34:16 > 0:34:19'and they're adamant it doesn't affect their prescribing.'
0:34:19 > 0:34:21The problem is that's what all doctors say, isn't it?
0:34:21 > 0:34:23We all go, "Well, I'll eat the sandwiches,
0:34:23 > 0:34:25"but I'll plug my ears for the talk."
0:34:25 > 0:34:27But we know that that isn't what happens.
0:34:27 > 0:34:30Sometimes you don't look at things.
0:34:30 > 0:34:32- Yeah.- So you're just used to doing things in a certain way...
0:34:32 > 0:34:35- I get it.- ..and it takes someone external to come in and say,
0:34:35 > 0:34:37"Have you thought about...?"
0:34:37 > 0:34:41'I hadn't understood how much...
0:34:41 > 0:34:43'they turned down.'
0:34:43 > 0:34:47And all my kind of anger and outrage is probably a bit misplaced.
0:34:47 > 0:34:49However, we will make Churchill
0:34:49 > 0:34:52a pharmaceutical industry-free practice.
0:34:56 > 0:34:59Following our meeting, the partners decide not to accept
0:34:59 > 0:35:01drug company lunches any more.
0:35:02 > 0:35:05It's a small victory, but my ultimate mission
0:35:05 > 0:35:08is to get as many people as possible off drugs.
0:35:08 > 0:35:13- Chris.- I soon have a patient at my no-drugs clinic who presents me
0:35:13 > 0:35:16with an excellent opportunity to do that.
0:35:16 > 0:35:19I was told that there are alternatives to taking
0:35:19 > 0:35:22the medication for things like blood pressure, diabetes,
0:35:22 > 0:35:24so I'm quite interested in that.
0:35:24 > 0:35:28'69-year-old Mike is taking ten tablets a day.'
0:35:28 > 0:35:29So you are rattling, aren't you?
0:35:29 > 0:35:33- Yeah.- Are you a well person or are you an ill person?
0:35:33 > 0:35:37Yeah, I do keep fit. I do two stamina swims a week.
0:35:37 > 0:35:39You're a fit man. We're just giving...
0:35:39 > 0:35:40I mean, look...
0:35:40 > 0:35:43There is something really weird about this pile of pills for someone
0:35:43 > 0:35:46who is well, who's never had a stroke and never had a heart attack.
0:35:46 > 0:35:49It's all about preventing stuff.
0:35:49 > 0:35:53'Mike's pills are for high blood 'pressure, high cholesterol
0:35:53 > 0:35:56'and type 2 diabetes, but I don't consider these diseases -
0:35:56 > 0:35:58'they're simply conditions that put him
0:35:58 > 0:36:02'at an increased risk of having a heart attack or a stroke.'
0:36:02 > 0:36:04Do you get side effects from any of the tablets?
0:36:04 > 0:36:07You do. You get quite a dry mouth,
0:36:07 > 0:36:09and certainly pain in the eyes.
0:36:09 > 0:36:11Now, the pain in the eyes comes from...
0:36:13 > 0:36:16..the blood pressure one.
0:36:16 > 0:36:18Do you want to take all the tablets?
0:36:18 > 0:36:22No. I don't want to take any.
0:36:22 > 0:36:24- Great to see you.- Chris, all the best.- I'll see you soon, Mike.
0:36:24 > 0:36:29There's no way that we like taking pills and you're thinking,
0:36:29 > 0:36:33"Oh, not another one. When's it going to end? Or is this it?
0:36:33 > 0:36:36"Is this what it's all about when you get old?"
0:36:36 > 0:36:40Mike's drugs are the most prescribed drugs in the country.
0:36:41 > 0:36:43NHS guidelines prompt doctors
0:36:43 > 0:36:46to put millions of people on these sorts of pills.
0:36:46 > 0:36:50It's a big issue and I need advice on how to approach it.
0:36:55 > 0:37:00Professor Sir Muir Gray used to be Chief Knowledge Officer of the NHS.
0:37:00 > 0:37:03Raised levels of cholesterol, raised blood pressure levels.
0:37:03 > 0:37:06You'll notice I'm not using the name of diseases.
0:37:06 > 0:37:08Raised level of blood sugar, type 2 diabetes -
0:37:08 > 0:37:13this is really where too much medicine has focused.
0:37:13 > 0:37:15But what these people have got, in my view,
0:37:15 > 0:37:17is they've got the problem of the modern environment,
0:37:17 > 0:37:21they've got walking deficiency syndrome or hyper-sitting syndrome.
0:37:21 > 0:37:24Muir thinks there's a simple way to treat these conditions
0:37:24 > 0:37:25caused by modern life.
0:37:25 > 0:37:30I would spend a lot more money on giving people support for exercise.
0:37:30 > 0:37:34And particularly physical exercise, I think we as a medical profession
0:37:34 > 0:37:36have completely underestimated,
0:37:36 > 0:37:39and last year the Academy of Medical Royal Colleges,
0:37:39 > 0:37:41which is a very august body,
0:37:41 > 0:37:45produced a report called Exercise: The Miracle Cure.
0:37:45 > 0:37:47I never thought I'd see that in my lifetime.
0:37:47 > 0:37:50A lot of the doctors say, "But we do, we tell people to exercise
0:37:50 > 0:37:53"and they come back a month later and they've done no exercise,
0:37:53 > 0:37:55"so they have to have a pill."
0:37:55 > 0:37:57Giving people supported programmes,
0:37:57 > 0:38:00not just giving them a bit of information or a bit of paper,
0:38:00 > 0:38:04giving people support can be as effective
0:38:04 > 0:38:07or more effective than medication.
0:38:07 > 0:38:11In our health care system, most patients are just told to exercise,
0:38:11 > 0:38:14rather than supported through it.
0:38:14 > 0:38:17I want to use Muir's advice to help patients like Mike
0:38:17 > 0:38:19with a programme of supported activity.
0:38:21 > 0:38:23I just have to figure out how.
0:38:27 > 0:38:30Crystal's been slowly coming off her painkillers.
0:38:30 > 0:38:34She's discovering how awful coming off opioids can be.
0:38:34 > 0:38:38Day four. I have been on the loo
0:38:38 > 0:38:42for pretty much most of the night.
0:38:42 > 0:38:45Diarrhoea and insomnia are common withdrawal effects.
0:38:45 > 0:38:48Feeling pain.
0:38:48 > 0:38:50Feeling it even more in my upper body today,
0:38:50 > 0:38:53but I'm guessing that's because I've not had much sleep.
0:38:55 > 0:38:57I'm really struggling today.
0:38:57 > 0:39:00I'm pretty hot at the moment, too.
0:39:00 > 0:39:02Today really sucks.
0:39:05 > 0:39:09Crystal will also need supported therapy if this is going to work,
0:39:09 > 0:39:12and I've found something unusual for her to try.
0:39:12 > 0:39:15- Crystal. - Hey.
0:39:15 > 0:39:18- Thanks for agreeing to meet me. - That's OK, I'm glad you're here.
0:39:18 > 0:39:21- You all right?- I'm very shaky. - You're looking a little shaky.
0:39:21 > 0:39:25- Yeah.- But you're going to be just fine, OK? Let's go.
0:39:29 > 0:39:32The man I'm taking her to meet is an expert in pain.
0:39:34 > 0:39:37Crystal, this is Dennis.
0:39:37 > 0:39:39- Hi, I'm Dennis. - Hi, nice to meet you.
0:39:39 > 0:39:42Attention. Bow.
0:39:44 > 0:39:49Dennis Ngo is a kung fu master who's been teaching for nearly 40 years.
0:39:49 > 0:39:52Stretch your groin.
0:39:52 > 0:39:54Keep your body upright.
0:39:58 > 0:40:02So, the logic about why we chose this kind of kung fu
0:40:02 > 0:40:06is because it's exercise, it's slow.
0:40:06 > 0:40:09I think more than anything else, we all believe,
0:40:09 > 0:40:11the team of people that have talked about you,
0:40:11 > 0:40:14that this can get inside your head and deal with your body.
0:40:14 > 0:40:15Yeah.
0:40:15 > 0:40:18'Many martial arts aren't just about combat.
0:40:18 > 0:40:21'They focus on breathing, posture,
0:40:21 > 0:40:25'mindfulness, and they condition practitioners to deal with pain.'
0:40:25 > 0:40:29Number one thing - don't tick off Dennis, OK?
0:40:34 > 0:40:37Dennis will see Crystal privately for a few lessons
0:40:37 > 0:40:39before she joins the class.
0:40:41 > 0:40:44How much do you want to get out of this?
0:40:44 > 0:40:47- Everything. I want... I really... - Do you really want to?- Yes.
0:40:47 > 0:40:52We take someone like you and we build them up very slowly.
0:40:52 > 0:40:54In...
0:40:54 > 0:40:58I'm taking Crystal into uncharted territory.
0:40:58 > 0:41:01There's no established scientific evidence that kung fu will work.
0:41:01 > 0:41:02Oh, sh...!
0:41:02 > 0:41:04I know, OK. Stay there. Come on.
0:41:05 > 0:41:09But Dennis has a deep knowledge of the human body.
0:41:09 > 0:41:13Gyrate it very slowly, the other side...
0:41:13 > 0:41:15Oh, shit!
0:41:15 > 0:41:18I need you to actually push a little bit through.
0:41:20 > 0:41:24The one thing I need you to do is not to search for pain.
0:41:24 > 0:41:28- A lot of people who have pain... - Yeah.- ..they look for the pain
0:41:28 > 0:41:30instead of allowing the pain to arrive.
0:41:30 > 0:41:33So, allow the pain to arrive, if it does.
0:41:33 > 0:41:36- OK.- If it doesn't, be surprised, be happy.
0:41:36 > 0:41:38- OK.- OK?- OK.
0:41:38 > 0:41:39Look up, look up.
0:41:39 > 0:41:42Keep your back straight. Look up. That's it.
0:41:42 > 0:41:45- I am going to stretch your back. - That feels great.
0:41:45 > 0:41:48Crucially, I think Dennis will inspire Crystal to accept
0:41:48 > 0:41:51that this will be a painful road to recovery.
0:41:51 > 0:41:52- Good.- It's good pain, it's good pain.
0:41:52 > 0:41:55- It's very good, isn't it? - Yep, it's great.
0:41:58 > 0:42:00- He's the real deal, isn't he? - He is.
0:42:00 > 0:42:04He spoke more sense about pain than I think almost any doctor
0:42:04 > 0:42:07- I've ever met.- That's why I said I wanted to take him back with us!
0:42:09 > 0:42:12I'm hopeful these classes will help Crystal.
0:42:12 > 0:42:13But even if it works,
0:42:13 > 0:42:17it is hard to imagine GPs adopting kung fu as a treatment plan.
0:42:19 > 0:42:23However, I've come up with something simple that Churchill's doctors
0:42:23 > 0:42:28might be able to use in place of a huge number of their prescriptions.
0:42:28 > 0:42:31I've arranged to meet Mike and a group of others who are taking drugs
0:42:31 > 0:42:34to lower their risk of heart attacks and strokes.
0:42:34 > 0:42:37There are thousands of patients like them at the surgery,
0:42:37 > 0:42:39and this group would like to stop.
0:42:40 > 0:42:42Hi, everyone. Thank you for coming.
0:42:42 > 0:42:44Sorry I'm late. Just as a straw poll,
0:42:44 > 0:42:47how many people here have had side effects?
0:42:49 > 0:42:52OK. So, six out of nine people.
0:42:52 > 0:42:55So I have a treatment that will reduce your risk,
0:42:55 > 0:42:57not just of having a heart attack or stroke,
0:42:57 > 0:42:59it will also improve your mood,
0:42:59 > 0:43:01it will reduce your risk of all kinds of cancers,
0:43:01 > 0:43:05it is essentially a miracle cure and it is side effect-free.
0:43:05 > 0:43:07- So, my proposition... - What's the catch?
0:43:07 > 0:43:09The catch is there is no catch.
0:43:09 > 0:43:11It's literally a total win, OK?
0:43:11 > 0:43:15So the proposition is... five times a week for 30 minutes,
0:43:15 > 0:43:18we're going to go for a walk, a brisk walk.
0:43:20 > 0:43:21What do you think?
0:43:22 > 0:43:27There are a few slightly sceptical faces around the group.
0:43:27 > 0:43:29I think we're going to have to see how this goes.
0:43:29 > 0:43:32OK, right, I will lead on.
0:43:32 > 0:43:33Keep up, everyone.
0:43:33 > 0:43:35Come on.
0:43:35 > 0:43:39'Something tells me this won't be a walk in the park.'
0:43:39 > 0:43:44I just hope I've got the motivation to keep doing it.
0:43:44 > 0:43:48It's commitment, it's fitting it into my lifestyle.
0:43:51 > 0:43:53We can all step out the door and go for a walk,
0:43:53 > 0:43:56but you sit in the chair instead, don't you,
0:43:56 > 0:43:58cos there's no-one sort of making you do it.
0:44:00 > 0:44:03They may not be so keen on walking now, but once they
0:44:03 > 0:44:06experience the benefits, I hope they'll be converted.
0:44:06 > 0:44:09Research has shown that walking regularly has astonishing
0:44:09 > 0:44:12healing powers, from reducing obesity
0:44:12 > 0:44:13to cutting the risk of cancer.
0:44:17 > 0:44:20'I want to see what effect walking will have on the conditions
0:44:20 > 0:44:23'they're taking drugs for, so we're measuring their blood pressure,
0:44:23 > 0:44:26'their blood sugars and their weight.'
0:44:26 > 0:44:28Patient number one, Michael.
0:44:28 > 0:44:30Hello.
0:44:30 > 0:44:31'I'll take these measurements again
0:44:31 > 0:44:33'when they've done eight weeks of walking.
0:44:33 > 0:44:37'We're also stopping a drug they've all been prescribed called a statin.
0:44:37 > 0:44:39'It lowers cholesterol,
0:44:39 > 0:44:42'and I want to see if walking can do the same job.'
0:44:42 > 0:44:44This is the entire NHS budget.
0:44:45 > 0:44:47Then you press the space bar.
0:44:47 > 0:44:49'I'm being helped by Catherine,
0:44:49 > 0:44:51'a senior nurse who manages their medication.'
0:44:51 > 0:44:55Do you think we're going to be able to relieve your workload
0:44:55 > 0:44:57a little bit by getting people walking?
0:44:57 > 0:44:59Realistically?
0:44:59 > 0:45:01- No. - Why?
0:45:01 > 0:45:04I've seen people can achieve great things with motivation,
0:45:04 > 0:45:09but something happens in their life and they get off track.
0:45:09 > 0:45:12These people get easily derailed.
0:45:12 > 0:45:15I'm hoping the fact they'll be walking in a group and that
0:45:15 > 0:45:17I'll be supporting them will make the difference.
0:45:19 > 0:45:22Sarah's treatment of cold water swimming has shown me how
0:45:22 > 0:45:25some patients need support to complete their therapy.
0:45:26 > 0:45:28She struggled to go by herself,
0:45:28 > 0:45:30so I arranged a swimming coach to help her.
0:45:33 > 0:45:35I want to see how she's getting on.
0:45:38 > 0:45:40It's just like the country.
0:45:42 > 0:45:44- We are in the country. - It is the country.
0:45:47 > 0:45:50Sarah's now been swimming regularly for a month.
0:45:50 > 0:45:52Thank you very much.
0:45:55 > 0:45:57I tell you what, everyone else is in wet suits.
0:45:57 > 0:45:58Yep.
0:45:58 > 0:46:01- But not us.- Nope. - I haven't got depression,
0:46:01 > 0:46:03I don't see why I can't have a wet suit.
0:46:03 > 0:46:05Everyone else is wearing one.
0:46:08 > 0:46:10That is not 19 degrees.
0:46:10 > 0:46:12When Sarah first started,
0:46:12 > 0:46:15she could barely swim 50 metres on her own.
0:46:15 > 0:46:17Now she's training to swim kilometres.
0:46:20 > 0:46:21Whoa!
0:46:23 > 0:46:26So, you've come a really long way.
0:46:26 > 0:46:31It's brilliant. I can't describe it, but it's lovely.
0:46:31 > 0:46:33I find that if I do have a low
0:46:33 > 0:46:36with anything or I'm having a particularly bad day,
0:46:36 > 0:46:39I find that if I come here, it solves it straight away.
0:46:39 > 0:46:40- Really?- Yeah.
0:46:44 > 0:46:46Up the stairs, darling.
0:46:46 > 0:46:49'I'm hoping the swimming has been a catalyst for positive changes in her life.'
0:46:49 > 0:46:51Hello.
0:46:51 > 0:46:56'The last time I came here, Sarah's house was full of clutter.
0:46:56 > 0:47:00'A lot of it belonged to her brother who died just over a year ago.'
0:47:02 > 0:47:04Look at this!
0:47:04 > 0:47:05I mean, wow.
0:47:05 > 0:47:09Right? So, last time I was here, you could hardly get around the bed.
0:47:09 > 0:47:10This is like a different room.
0:47:10 > 0:47:13It's really nice. You're in the room with someone who's
0:47:13 > 0:47:16got a kind of organised life and organised head,
0:47:16 > 0:47:18and someone who's got their act together.
0:47:18 > 0:47:20Yeah. That's how I feel.
0:47:20 > 0:47:25'She's now working with her GP to wean herself off her antidepressants.'
0:47:25 > 0:47:27I'm on 20mg now, and...
0:47:27 > 0:47:29Hold on, and you were on 40.
0:47:29 > 0:47:32- I was on 40.- So you've halved? - Yep.- OK.
0:47:32 > 0:47:36Yeah, I feel a lot more energetic, it's nice to feel a little more...
0:47:36 > 0:47:38me.
0:47:38 > 0:47:40Evie, how's Mum been?
0:47:41 > 0:47:44Yeah. We've been all good, isn't it?
0:47:44 > 0:47:46'Sarah's still got some work to do,
0:47:46 > 0:47:48'but she's now on the right track to getting off
0:47:48 > 0:47:50'the antidepressants for good.'
0:47:52 > 0:47:53In Sarah's case, lasting happiness
0:47:53 > 0:47:56is going to come from exercise, diet,
0:47:56 > 0:48:00friendships, her job, the way she's bringing up Evie, her relationship.
0:48:02 > 0:48:05That is what you can't put in a pill, and that,
0:48:05 > 0:48:09I think in Sarah's case, is what the drug was stopping her doing.
0:48:12 > 0:48:15With Sarah doing so well, I want to see how Crystal's getting on.
0:48:16 > 0:48:2012 weeks ago, her chronic pain left her barely able to move,
0:48:20 > 0:48:22despite taking 30 pills a day.
0:48:24 > 0:48:28I've adopted a radical approach to get her exercising - kung fu.
0:48:30 > 0:48:33There is no good treatment for chronic pain,
0:48:33 > 0:48:37so if we've made a dent in it and at least she's not on
0:48:37 > 0:48:40pills that she hates and were causing her side effects,
0:48:40 > 0:48:42that will be good.
0:48:43 > 0:48:44I'm nervous.
0:48:44 > 0:48:48This is the first time I've seen her in over two months.
0:48:59 > 0:49:02Oh, my God.
0:49:02 > 0:49:04She's standing on one leg.
0:49:04 > 0:49:06She's smiling.
0:49:06 > 0:49:08She's laughing.
0:49:08 > 0:49:09Look.
0:49:15 > 0:49:19She's moving. I haven't seen her wince or hold her back or...
0:49:22 > 0:49:24Hello.
0:49:24 > 0:49:27How are you? I'm sorry, I'm smelly and sweaty now.
0:49:27 > 0:49:29Look, look, look.
0:49:31 > 0:49:34So, I was just watching you the last little bit from outside the door.
0:49:34 > 0:49:36I'm completely blown away.
0:49:38 > 0:49:42Cool. Well, I've worked bloody hard, to be honest, to get here,
0:49:42 > 0:49:45and Dennis is a pretty good drill sergeant.
0:49:45 > 0:49:47- How has it been? - I've been very, very proud of her.
0:49:47 > 0:49:49Very. She wanted it.
0:49:49 > 0:49:51Honestly, she wanted it.
0:49:51 > 0:49:55No-one can get her to do what she does if they're not ready.
0:49:55 > 0:49:56And she really wanted it.
0:49:56 > 0:49:59- You know, I'm very... - I feel like a good student.
0:49:59 > 0:50:01- I'm very proud of you. - Thank you so much.
0:50:01 > 0:50:03Much appreciated.
0:50:03 > 0:50:06It's learning to stand, learning to walk. Even the slightest thing,
0:50:06 > 0:50:09you know, Dennis will come round and say, "Your head's not straight,"
0:50:09 > 0:50:12and do that, and I don't even notice cos it's what we're used to.
0:50:12 > 0:50:18So it's been good. Don't get me wrong, I have bad days still,
0:50:18 > 0:50:20but not like I had before.
0:50:20 > 0:50:25I just think you are the poster girl for what harm drugs can do
0:50:25 > 0:50:30and how there are other things you can do apart from taking pills.
0:50:30 > 0:50:33- No pressure.- Give me a big old hug. - Thank you. Sweaty hands.
0:50:33 > 0:50:34Dennis, give me a hug.
0:50:37 > 0:50:40Crystal's transformation shows that exercise
0:50:40 > 0:50:42really can be a miracle cure.
0:50:43 > 0:50:47It benefits the whole body, from the brain to the bones,
0:50:47 > 0:50:49enhancing its ability to heal itself.
0:50:53 > 0:50:57But bringing this miracle to my walkers is proving hard.
0:50:57 > 0:51:00So, is this normal, that it's just two people?
0:51:00 > 0:51:02Well, it has been for the past three nights.
0:51:02 > 0:51:05This is a disaster.
0:51:05 > 0:51:06It is.
0:51:06 > 0:51:08Hi, is that Sophie?
0:51:08 > 0:51:11It's Chris here. I know you're not being lazy...
0:51:11 > 0:51:13'I'm determined to make sure the group gets the support
0:51:13 > 0:51:15'it needs to thrive.'
0:51:18 > 0:51:20Spiky!
0:51:20 > 0:51:24'This walking programme could easily be rolled out at the surgery.'
0:51:24 > 0:51:26Spike, my mother-in-law's dog.
0:51:26 > 0:51:29'Thousands of their patients are on medication to lower their risks
0:51:29 > 0:51:32'of heart attacks and strokes.'
0:51:32 > 0:51:35That's no way to say hello.
0:51:35 > 0:51:37That's it. Once he gets going, there's a lot of momentum.
0:51:37 > 0:51:40'But I've got to keep my test group walking regularly
0:51:40 > 0:51:42'so I can demonstrate the benefits.'
0:51:42 > 0:51:44You're going a bit faster.
0:51:44 > 0:51:48'Five walks a week, 30 minutes a day is all it takes.'
0:51:48 > 0:51:52Two miles. Pace, 15.37.
0:51:52 > 0:51:53My pain in my leg's gone, though.
0:51:53 > 0:51:56- Has it?- When I used to kneel down, I could never get up,
0:51:56 > 0:51:58but it's gone now, I can't believe it.
0:51:58 > 0:52:01What I said at the beginning of this - walking is a miracle cure.
0:52:01 > 0:52:03They're certainly feeling the benefits,
0:52:03 > 0:52:06but has the walking lowered their risks of heart attacks?
0:52:06 > 0:52:08Michael Smith?
0:52:08 > 0:52:10The eight-week experiment is over.
0:52:11 > 0:52:13- Ouch. - There's always one.
0:52:15 > 0:52:19- Come in, have a seat.- Before the group started walking, they had
0:52:19 > 0:52:22their baseline measurements taken for various conditions they have...
0:52:22 > 0:52:24Mummy's big and brave.
0:52:24 > 0:52:28..from type 2 diabetes to high blood pressure.
0:52:28 > 0:52:31They even stopped taking their statins so we could measure
0:52:31 > 0:52:34the effect the walking had on their cholesterol levels.
0:52:38 > 0:52:40I'm nervous about the results.
0:52:41 > 0:52:43- Hi, Catherine. - Hi, Chris.
0:52:43 > 0:52:45- You got something for me? - I've got the results.
0:52:45 > 0:52:47Lordy, lordy.
0:52:47 > 0:52:48'It's good news.
0:52:48 > 0:52:52'The blood sugar levels of the walkers with type 2 diabetes
0:52:52 > 0:52:54'have changed dramatically.'
0:52:54 > 0:52:55His HbA1c...
0:52:55 > 0:52:59This is the measurement of how good his diabetes has been
0:52:59 > 0:53:03over the last few weeks. It's now 57 from 75.
0:53:03 > 0:53:05- That's fantastic. - I mean, that...
0:53:05 > 0:53:07Is that a good result? You see this the whole time.
0:53:07 > 0:53:09- Yeah.- Is it?- Absolutely.
0:53:09 > 0:53:12- Oh, I'm so... - I'm very pleased with that.
0:53:12 > 0:53:15'It's an effect seen across all the diabetic walkers.'
0:53:15 > 0:53:18Her HbA1c has gone from 56..
0:53:19 > 0:53:21..to 48,
0:53:21 > 0:53:25and 48 is kind of the sort of minimum that gets you
0:53:25 > 0:53:28to be called a diabetic,
0:53:28 > 0:53:32so actually she's starting to come toward,
0:53:32 > 0:53:35you know, stopping being diabetic.
0:53:35 > 0:53:36And that's in eight weeks.
0:53:36 > 0:53:38Which is really significant.
0:53:38 > 0:53:41It's better than some of the new drugs say they can do
0:53:41 > 0:53:43in a few months, isn't it?
0:53:43 > 0:53:47Not only that, the walkers' blood pressures dropped, they lost weight,
0:53:47 > 0:53:50and even their scores in mood tests soared.
0:53:52 > 0:53:5537 to 51.
0:53:55 > 0:53:57That's massive.
0:53:57 > 0:53:58I mean, that is massive.
0:54:00 > 0:54:03If the group keep this up, there's a chance they'll be able to cut out
0:54:03 > 0:54:06the drugs they're taking altogether.
0:54:06 > 0:54:10Now they feel the benefits, they're motivated to carry on.
0:54:10 > 0:54:13And even though their cholesterol levels remain high,
0:54:13 > 0:54:16none want to start taking their statins again,
0:54:16 > 0:54:19preferring to try and lower their levels naturally.
0:54:19 > 0:54:23But Mike has the highest risk of having a heart attack,
0:54:23 > 0:54:26and taking a statin again is the quickest way to reduce it.
0:54:26 > 0:54:29So, this is quite an interesting chat that we've got to have.
0:54:29 > 0:54:32You are at a level of risk where I start to go,
0:54:32 > 0:54:34"Maybe I would take a statin."
0:54:34 > 0:54:38You have reduced your risk by losing weight. You have reduced your risk
0:54:38 > 0:54:41with blood pressure. But your absolute risk is still high.
0:54:41 > 0:54:44Well, what comes to my mind is...
0:54:44 > 0:54:47Let me do a three-month trial,
0:54:47 > 0:54:50then do another blood test and see what the results are.
0:54:50 > 0:54:53So, when you've got the opportunity to come off a pill,
0:54:53 > 0:54:57it's like coming out of prison, you know, you've been released,
0:54:57 > 0:55:00you're feeling different in your mind, a bit younger.
0:55:03 > 0:55:06'I decide to take what I've found to the doctors.
0:55:06 > 0:55:09'I hope they'll be as impressed as I am by the blood test results.'
0:55:09 > 0:55:12- So, you guys don't know the results? - We don't know, no.
0:55:12 > 0:55:15Mike, I guess, had the biggest result where his HbA1c
0:55:15 > 0:55:19went from 75 to just over 50.
0:55:19 > 0:55:22That level of reduction, that's quite impressive.
0:55:22 > 0:55:23That is good.
0:55:23 > 0:55:26We don't always get results like that with drugs as well.
0:55:26 > 0:55:29- Did they lose weight?- Every single person lost weight, yes.
0:55:29 > 0:55:32Walking as treatment for diabetes, as a way of reducing your risk of
0:55:32 > 0:55:35strokes, heart attacks and death suddenly starts to feel like,
0:55:35 > 0:55:38- "Oh, that's really good." - If, within the practice, we have,
0:55:38 > 0:55:42you know, a diabetic walking group set up,
0:55:42 > 0:55:43to me that's absolutely fantastic.
0:55:43 > 0:55:47- Really?- It's something the practice should be supporting.
0:55:47 > 0:55:50I'm so pleased that they feel it did pay off.
0:55:50 > 0:55:54I mean, imagine if GPs all over the country were able
0:55:54 > 0:55:58to support patients like this. You know, we'd see reductions
0:55:58 > 0:56:02in medications for blood pressure and cholesterol and diabetes.
0:56:02 > 0:56:05But I think there's something much more important than that,
0:56:05 > 0:56:08that we really saw with Mike and Janet, particularly,
0:56:08 > 0:56:11all these things it's hard to measure - their mood improved,
0:56:11 > 0:56:14they slept better at night, they felt like they were in charge
0:56:14 > 0:56:18of their own health and their own bodies.
0:56:18 > 0:56:19You can't put that in a pill.
0:56:21 > 0:56:23I'm at the end of my time here,
0:56:23 > 0:56:26and I now realise the real problem isn't simply the drugs
0:56:26 > 0:56:28but our health care system itself.
0:56:29 > 0:56:33We hand out pills when often we should be supporting people
0:56:33 > 0:56:35through drug-free alternatives instead.
0:56:39 > 0:56:41If you say, "I want to go walking," your doctor says,
0:56:41 > 0:56:44"Well, go walking," and that is it.
0:56:44 > 0:56:47Where's the support? We all know that we won't do it.
0:56:47 > 0:56:49The "health service",
0:56:49 > 0:56:53if it is to be a health service and not a drug prescription service,
0:56:53 > 0:56:57needs to be able to support people doing those difficult, long-term,
0:56:57 > 0:57:02but ultimately massively rewarding and health-giving things.
0:57:03 > 0:57:07In just a few months, I've witnessed extraordinary transformations...
0:57:09 > 0:57:12..as my patients have turned their backs on drugs.
0:57:14 > 0:57:16If we can empower doctors across the country to help millions
0:57:16 > 0:57:20of patients do the same thing then, in the future,
0:57:20 > 0:57:24prescriptions could mean something much more powerful
0:57:24 > 0:57:25than just pills.