Episode 2 The Doctor Who Gave Up Drugs

Get your pills. Honest pharmacy.

We are selling pills with side effects guaranteed.

'My name is Chris van Tulleken. I'm a doctor.'

Gastric bleeding, sir?

'I've been searching for solutions to a medical crisis that affects 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.

That's over 15 courses of medicine for every man,

woman and child in this country.

If you've got a headache, take paracetamol.

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

Aaah.

Drugs certainly save lives,

but this binge on medicines is dangerous.

That is an overdose.

How could this ever be good for a human being?

Millions suffer 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.

I've been working at a GP surgery in North East London,

trying to treat patients without drugs.

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

I faced worried doctors...

Stopping things could be downright dangerous.

..and sceptical patients.

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

Now I want to use what I've learned to supersize my experiment

and get as many patients as I can off drugs.

SHE GROANS

I'll take a group of people at risk of a heart attack off their medication.

So, hand over your drugs.

But persuading Britain to go cold turkey...

This is a disaster.

..could be the hardest thing I've ever done.

Fix me, please.

Intensely depressed about how to make it change.

Churchill Healthcare, Pat speaking. Can I help? I've got the morning.

Morning's no good, is it?

Churchill Medical Centre is a busy GP surgery in Chingford,

North East London.

-Who's up next?

-Tina Hill?

It looks infected.

I'm working with the doctors here to try and find ways to reverse

the steep rise in how often we pop pills.

-Take care, my love.

-Thanks, guys.

In the 14 years I've been a doctor,

prescription rates have shot up by over 50%.

Thank you very much. Cheers.

Kevin Wingrove?

Do you want injections?

Do you want pills?

Do you want an operation?

Drugs benefit countless lives, but they can cause side effects,

from headaches to stomach bleeds,

and our overuse is now a major public health concern.

Do you think we could just give you some nice fruit juice?

Yeah.

I believe we should be turning to new research that suggests

many common illnesses are best treated without drugs.

Clean socks, clean feet...

-Yep.

-..and keep them warm.

The doctors here think over-prescription is a problem, too,

but they're sceptical about how likely I am to make a difference.

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.

Nonetheless, I've been encouraged by a few successes.

Wendy had been using medication for her bad shoulder for 20 years,

and now she's drug-free.

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

Oh, my God. Thank you so much.

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

-You've totally inspired me.

-Thanks for everything you've done.

So far, I've been treating specially selected cases,

but I want to make a real difference by offering drug-free treatments

to all 14,000 patients at the practice.

-Morning.

-Good morning.

Today is the first day I am going to run my drug-free clinic.

I'm offering patients 30-minute appointments,

20 minutes longer than they'll get with their GPs.

The extra time will help me work out what pill-free therapies

to offer them.

So I put out my sign for the clinic.

-Oh, right.

-I've got my three waiting seats upstairs,

so if those seats are full, can you get people to sit out here,

-you know...?

-Cool.

The public will get the chance to choose me or see their doctors.

Neither of you are interested in coming to my drug-free clinic?

-Um, no.

-I don't understand how they could prescribe something

and then not give a prescription. I don't get that.

So, at the moment, prescriptions are an awful lot more popular

than my non-prescription clinic.

Yes.

Has anyone expressed any interest at all?

I don't know about out there, but not to me.

No-one's said anything all morning? And you've been here all morning?

I have.

I'm not sure where I'm going wrong.

Come in.

Hey, Kam.

'Dr Kam Seehra is a partner here.'

So I'm trying to run my drugs-free clinic in the room upstairs

and it's not working, and I don't know why.

I think it's because patients, for want of a better word,

want a quick fix. Society nowadays,

you just haven't got time to deal with the lifestyle changes.

Basically, it's about motivation,

and I think that motivation is going to be your struggle, really.

For a lot of people it's easier to take that tablet.

How am I going to deal with this? What can I do?

You might actually want to target some patients

who are on painkillers and some of the more common medications,

perhaps antidepressants.

Sometimes they're not as effective as the patient might think.

I've got some ideas on how to motivate patients,

but first I've got to sign some up.

So I have some leaflets.

The No Drugs Clinic.

For an appointment, it's room nine.

-Perfect.

-Good. All right.

-No problem.

The receptionists have agreed to do some marketing for me,

to find the kinds of patients Kam's suggesting.

Cheers, guys.

For the last three weeks, I've been working with someone

who's taking a drug I've been recommended to target.

Antidepressants do help some people,

but 24-year-old Sarah has been taking hers for eight years.

I need my eyeballs by the end of it.

After I introduced her to cold water swimming,

Sarah decided to give it a try in place of her pills.

-How do you feel, Sarah?

-On top of the world.

THEY LAUGH

Research carried out at the University of Portsmouth suggests

that swimming in cold water could help treat anxiety and depression.

When was the last time you felt this good?

-When my little girl was born.

-Really?

-Yeah, really.

But before she starts to come off her drugs,

I want Sarah to be benefitting from swimming outdoors regularly.

It's the weekend and it's two weeks since we swam together.

-Hey, Sarah.

-Hiya.

How are you feeling today?

Erm... Pretty rubbish at the moment.

Yeah, I mean, you look almost tearful, if I'm honest.

-No, you can't see.

-No?

I'm not tearful.

Yeah, unfortunately, the resolution is really good and I can see

your eyes filling with tears.

I'm only laughing because you are.

So how's the last week been?

Well, unable to get any sort of childcare, so I haven't been able

to go swimming, which I'm quite upset about.

I seem to have had a bit of a come-down.

It's hard this, isn't it? Because, to put this

in the starkest medical terms,

you have a medical problem for which you need to go and have treatment,

and if you were going for chemotherapy,

if you were going for an operation, everyone would give you childcare.

I think this is no less important.

So, yeah, why could you not have gone today?

Today? I don't want to today.

Yeah, that's the biggest reason - I don't want to today.

Yeah.

I'm miserable.

I'm fed-up.

Yeah.

So, you've lost a bit of momentum?

Yeah.

Today, yeah.

What you're describing is the thing that screws us all up.

This is kind of the anatomy of failure.

We fail one tiny, tiny, tiny bit at a time,

and we miss it one week and then it's easier to miss it

the next week, then it's easier to miss it the next week.

But you need to make these swims like doctor's appointments, OK?

-It's just been a bad week.

-All right, all right.

I'll speak to you later then.

OK. All right. Bye.

Oh, I feel naive.

I just feel like, "Oh, God."

You know, I just thought we could dunk her in cold water

and she'd feel better.

I'm hoping the pep talk will get her swimming,

but I'm beginning to doubt my approach.

But there's good news back at the surgery -

after hundreds of phone calls, I'm starting to get interest

in my no-drug clinic.

Crystal. Come on in.

-Do you want a hand?

-Please.

What do you want to get...? I'll get the handbag, I'll get the bags.

Tell me what the issue is.

I'm in pain every day, just kind of varying degrees.

I've got it going up my neck.

I get a lot of pain down my right side.

I mean, you're obviously in a lot of pain now,

sitting here talking to me.

I'm actually... This is a good day.

What do you want, in the broadest possible way?

I just want to be normal.

I just want to work and live, rather than feel like I'm existing.

Crystal is 36, and she's been like this for three years.

Long-term, or chronic, pain is surprisingly common.

14 million people in the UK suffer from some form of it.

But Crystal's case is extreme,

and her doctors don't know what to do with her.

So there's nothing that anyone has been able to find,

specialists or GPs, that explains why she's having

all this really severe pain?

In a nutshell, no,

and it's difficult to manage if you don't know where it's coming from.

'Doctor Nausheen Hameed is overseeing Crystal's care.

'Physiotherapy hasn't worked and they're relying on

'powerful painkillers to help her.'

Left to general practice, what would happen?

It would continue to cycle between a referral here, a referral there,

back to us for repeat prescriptions the next five, ten years.

And that's sad, actually.

-Nausheen, thanks very much.

-You're welcome.

-I will go and try

-and find some way of doing this without drugs.

-Well, good luck.

All the best. Bye.

-I'll keep you informed.

-Thank you.

Trying to get her off the medications is an amazing idea,

but I think it's going to be a struggle.

She's been on them for such a long time and, you know,

they are controlling her pain to some extent, and I just worry that,

you know, how is she going to cope without them?

It's estimated that millions of people live with pain

that has no apparent cause,

but for patients like Crystal, the suffering is very real.

I am not an expert in chronic pain, so I want to find out

what is it like to try and live at home in that amount of pain?

Hello?

Hi, Crystal, it's Chris.

Here we are.

Smiling but moving slow.

-Sorry.

-Don't be sorry. How you doing?

-At the moment, not too bad.

But I have been known to come up here on my bottom.

Not dignified or comfortable.

No. None of this is dignified.

And this is what I do.

But I can't stay in that position for too long

because my neck starts to hurt.

I'm sorry, I took some meds a little while ago, so now I'm starting to...

You're a little bit slow...

-Foggy.

-..and a little bit foggy, yeah.

Don't worry. Give me the tour.

You've got a feature wall.

Of course. Changing Rooms - it was my programme in the day.

Crystal lives here with her teenage son.

I was in the gym when I was first made aware that there was something

wrong with my back. I was training for a 10k run...

Cancer Research.

They basically could hear my back, it was that loud, and came over

and said, "Look, you need to go and get that checked out."

And then, within a short space of time,

I just couldn't move or anything without screaming out in pain.

Crystal now spends most of her time trapped in this flat.

She can't work and she's only able to get out

after elaborate preparation.

This is my corset.

It just stops my back, or rather my tail bone,

from feeling like it's going to pop right through the skin.

And she doesn't go anywhere without her neck brace.

Today we're off to pick up her month's supply of painkillers.

What's so bad about the bus?

Right now, exactly what he's doing, just braking -

all of that I can feel.

Just bloody painful.

Hopefully they won't have run out.

-No.

-So, is this it?

It is today. I normally have two.

-Normally you have two? It's heavy.

-Thank you.

Take care. See you later.

I'm amazed at just how many drugs Crystal's picked up,

and I'm worried what it's doing to her.

Spread the drugs out.

That's the heaviest bit of shopping.

-So I have my codeine...

-OK.

-..which is a pain reliever.

I take four of those four times a day.

So, you're taking 16 of these per day?

-Yes.

-That's a huge dose.

'Codeine is related to morphine and heroin, and it can be addictive.'

This one is the tramadol, and I'm taking that three times a day.

OK. So that's a stronger version of codeine.

A stronger version of the codeine,

and I take those, basically, together.

'These drugs are called opioids.

'They're similar to pain-reducing chemicals produced by our bodies

'called endorphins. They cause side effects like constipation

'and nausea, and Crystal has to take even more drugs to deal with those.'

If I was taking all of this and I felt pain-free

then I would at least feel like I was achieving something

by taking this amount of medication, but I'm still not pain-free.

I don't get why you're taking these pills. I'm not sure you get why you're taking the pills,

but is it just because there is nothing else to do?

Seriously, yeah. Yes, is the short of it.

I'm pretty sure the answer doesn't lie in those pills,

but rather in exercise and physical therapy but, at the moment,

Crystal's so immobile

I'm not sure if she'll be able to do anything at all.

I feel positive because I think

Crystal is at least willing to try and do the hard work,

but I don't think she's got a clue about how hard this is going to be.

I need a swimming bag.

A swimming bag would be a good idea.

It's been a week since I spoke to Sarah,

and she's responded well to my pep talk.

Today she's going cold water swimming again with her partner

at a nearby lake.

I want that feeling back.

It just gets on top of you when you suffer with depression.

Everything builds up and you do need a stress relief,

and antidepressants don't do that.

A bracing swim in 13-degree water will hopefully do the trick.

Do I look attractive?

It's the first time she's been in cold water since I took her swimming

in Portsmouth over a fortnight ago.

How is it, Sarah?

Actually quite nice.

A lot nicer than Portsmouth, but still quite chill.

I'll be back. I'm going to go swimming. See you in a bit.

Exposing the body to the shock of cold water can leave people

feeling euphoric. Some scientists think it may even condition them

to help deal with other stresses in their lives.

But Sarah doesn't stay in very long.

I can't breathe.

I started looking at the water and I started feeling like I wasn't

moving anywhere. It was horrible. I thought I was going to drown.

Tell me what happened.

I swam out quite far on my own, and then I think I had nobody with me,

so I started to panic, thought I was going to drown,

freaked out and swam back.

What can we do next?

How can we make this so it isn't terrifying every time?

I think I found when I was in Portsmouth that swimming with somebody helped.

-Right.

-So...

Yeah, probably that would help.

All right, we will figure something out and I will get back to you, all right?

Sarah needs to just have someone to hold her hand in the way

that doctors, nurses and pharmacists do when you start a course

of prescription medication.

Down another inch. Good stuff.

I've decided to get Sarah a swimming coach to support her.

She's been on antidepressants since she was a teenager,

and coming off them can be hard.

Between 2005 and 2012,

the number of young people prescribed these drugs shot up

by 54%. For many, the first step is filling out a simple form.

So I have here the PHQ-9 depression questionnaire,

and this is one of the most common tools that GPs use in the UK

and all around the world, so I'm going to see if I am depressed.

So, the questionnaire.

"Over the last two weeks,

"how often have you been bothered by any of the following problems?"

Problem one. "Little interest or pleasure in doing things."

So, for several days, I have definitely had little interest

or pleasure in doing things.

Number two. "How often over the last two weeks have you felt down,

"depressed or hopeless?"

I haven't felt hopeless at any point in the last couple of weeks,

but I have felt down or depressed.

Some doctors use this test to help them prescribe

and monitor antidepressants.

"How often have you been bothered by poor appetite or overeating?"

I mean, I just perpetually overeat.

But it's also on the NHS website, allowing anyone to test themselves.

And then we add up the score.

"Based on your responses today, it's very likely

"you could be suffering from some form of depression,

"but only an experienced health professional can tell for sure."

So, according to this, I have moderate depression,

and I'll tell you, I do NOT have moderate depression.

The striking thing about this is that there is not

a single positive question on it.

Ask me some other questions.

Ask, "How often have you felt happy and positive about your life,

"every single day?"

This is a questionnaire that does its best to force you to think

about how miserable your life is and how unhappy you are.

This is a questionnaire that was developed by a drugs company,

by a drugs company who make drugs that treat depression.

This isn't the first time I've noticed the influence

of pharmaceutical companies.

Just looking around the office...

Pneumovax II.

We've got a little duck here - Sanofi-Aventis, drug company.

You know, that just reminds you that you can use that flu vaccine.

Sponsored by GlaxoSmithKline.

Yeah, this is a model of the female genital tract.

You show the model to patients,

and all the while there's a little branding there reminding you.

It's just having the marketing here prompts people

to prescribe those brands more.

It's just sort of the hidden hand of the pharmaceutical industry

in the office.

And the marketing doesn't stop there.

Clinical meeting.

I'm on my way to a meeting the GPs are having

at another surgery nearby.

There's a lunch to go with the meeting, and the lunch is,

we've heard, sponsored and paid for by a drug company.

And this is completely normal, OK?

This happens in hospitals,

in general practices all over the country every day,

and my honest opinion is it is a total, total disgrace,

and it's the only thing

that I've yet heard about with this practice that makes me...

kind of wince.

It's a bribe.

It's a simple bribe.

The drug reps provide the food,

and in return they get an opportunity to talk up

their latest products.

-Where's lunch happening?

-It's the second floor.

'These lunches are a regular event.'

Is it a good selection of sandwiches, normally?

-Yeah.

-Indian last week.

On the menu today, a selection of upmarket salads and sandwiches.

I want to know more, but the drug company rep has a word with the GPs.

-Sorry, just while the drug reps are here.

-Oh, you can't be called...

You can be in here but we can't be called while drug reps in here.

The rep gives his talk and, ten minutes later, he leaves.

Why do you have drug reps come at the beginning

of the clinical meeting?

-Be honest?

-Completely honest, yeah.

Have you just finished the truth, is that...?

I'm about 90% of the way through the truth.

Yeah, I'm eating the evidence.

I mean, what they hope is it affects our prescribing data and the drugs

they prescribe, and every doctor you speak to will tell you categorically

it doesn't affect it.

The practice use the free lunch to get together

and talk shop, but, in fact,

recent research shows that doctors are more likely to prescribe

certain drugs if they take meals from drug reps.

So I went in there and I swore that I wouldn't eat any of the food,

and then midway through the meeting I realised that I had started

to eat a tangerine.

We know it influences prescribing,

the drug companies know it influences prescribing.

This is a multi-multi-billion dollar industry

with deep pockets and huge focus, and I don't know how we combat this.

First I'll try to get an explanation from the drug company rep

supplying the lunches.

Chris van Tulleken here. I just wanted to give you a ring

to see if you'd be willing to have a chat with us on camera.

Thanks very much indeed, and we'll speak soon. I'll bung you over an e-mail this afternoon.

All right. Cheers, bye.

He does seem like a really nice bloke.

In principle, if the communications team at his drugs company

are willing for us to speak to him, he's willing to speak to us.

That should be nice, ask him some questions.

So I'll write him an e-mail now.

I'll wait for him to get back to me.

Meanwhile, I've got an important appointment with

chronic pain sufferer Crystal.

So, we're going to see a physio

who is a really, really good physio.

OK.

Because I want him to...

assess you, because he works with a lot of people like you

who have chronic pain.

Have you got any questions?

No, not really, just can we get there quicker?

I'm not knocking your suspension!

THEY LAUGH

Getting appointments with NHS physiotherapists can take months,

so I've had to go private.

-Hi. Rob Madden, pleased to meet you. How are you?

-Nice to meet you.

-Would you like to come down?

-Yep.

Bend your knee up towards you again, slowly.

Yeah, it's hurting.

Crystal's previous attempts at physiotherapy have failed, but

I hope this assessment will give me clues on the best way to treat her.

Oh, my God, OK.

Now I've got upper body pain, too.

OK. You are doing absolutely fine.

This is how I get up out of bed.

Chronic pain can be caused by a range of things,

from damaged nerves to joint problems.

Even the way the person perceives the pain can play a role.

But Crystal's pain is worse because she's stopped moving

and has grown weak.

Oh, Jesus.

You OK?

I need to find a way to build up her strength.

So what do you think?

My outright concern is, at the moment,

if you take her off her medications and ask her to do more physically,

then there's a high chance that she could have a bit of a flare-up,

so all of her back pain could actually get worse.

My gut instinct is that she will struggle without medication.

So it's not just that my

plan might fail, it's that I might make her much worse.

That could happen. We need to take small steps.

Rob wants me to get a second opinion.

I still believe Crystal can get off these drugs.

I do, I think her problems...

A huge amount of her problems are caused by drugs.

This used to be called black gas.

I'm meeting Dr Cathy Stannard at an exhibition containing some of

the earliest forms of pain management.

"Oxford Vaporiser. Portable self-contained ether vaporiser

"for use in battle conditions."

Dr Stannard is one of the country's top consultants specialising

in chronic pain.

What do you think in general?

Your totally honest, blunt opinion about what I'm trying to do,

about my attempt at a drugs-free clinic.

Well, actually, in evidence terms, it's really sensible.

-Really?

-Certainly in pain, that makes sense.

We know that medications aren't the answer.

There is no evidence for effectiveness of opioids

-in the long term.

-There's no evidence that they work at all?

There's no evidence. Even with somebody with long-term pain,

if you start off they may well work for four to six weeks,

and after that they will stop working.

What proportion of people are harmed?

Cos you're saying we're giving out more and more of these kind of drugs

-in this country.

-I think it's difficult to put a figure on.

What we know for sure is that about 80% of people taking a drug,

taking an opioid, will have at least one adverse effect.

But we also know is that there are some more serious harms that are

associated with high doses over longer periods, so, for example,

disruption of hormones, changes in the immune system.

Really?

With long-term exposure,

the drugs can actually make pain worse rather than better.

Hi, Crystal, it's Chris.

Dr Stannard agrees Crystal should try and come off the drugs

if she feels able. She and crystal's GP have made a programme

to wean her off them safely.

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

-OK.

-..in the way that you've been taking them.

'This won't be easy.

'Cutting down means that Crystal may have unpleasant withdrawal effects.'

The tramadol and the codeine -

they're addictive in the same way that heroin is...

-Yeah.

-..that morphine is, so we need to taper these off

so that coming off them isn't worse than staying on them.

So phase one is tapering, but we're not just going to do that,

we want to actually try and fix you as well.

Over the next few weeks, her doses of drugs

will get smaller and smaller.

-Cheers, Crystal.

-Take care.

-I'll see you soon.

-Thank you.

-Bye.

-Bye.

I'm also going to have to find a long-term solution that really works

to take the place of the drugs.

But first I'm turning my attention back to putting a stop to

the lunches at the surgery paid for by the pharmaceutical industry.

You might think I'm getting a bit worked up about a few sandwiches

given out at a GP's practice in Chingford

by a pharmaceutical industry rep.

Not a big deal. Small beer.

Let me show you why I'm getting worked up.

OK.

Over the last few years, OK,

the drugs industry has paid 13 billion in fines

in the US alone.

The fines are for a range of unethical activities,

including bribing doctors to prescribe their drugs.

While the lunches drug companies buy are perfectly legal,

I'm uncomfortable with them having such direct access to our doctors.

We get amazing drugs from them, but anyone who thinks

that a representative from a drugs company is going to give

totally independent, unbiased information about their product

is, frankly, insane.

The drugs rep has been told not to speak to me,

so I've come to the Association of the British Pharmaceutical Industry,

a body that represents drug companies in the UK,

to speak to Dr Virginia Acha.

We have filmed an awful lot of pizzas and sandwiches

and soft drinks and apples and packets of crisps

that are given out by pharmaceutical industry reps,

and that really concerns me.

OK, and it should. So we do have a code of practice,

so if their was evidence being presented there, it should be

proper scientific evidence.

So you're comfortable with your NHS GP being educated by someone

who is employed directly by an industry that is selling drugs?

I would be concerned if my GP was not aware of all the different

treatment developments that were happening,

but what's interesting to me is the people who really get informed

at those meetings are the very same company representatives,

because they're hearing questions

that perhaps were not thought through when the company was putting

together whatever material needed to support it,

or there's an insight about how care could be better delivered.

If we don't have that feedback from the doctors about the quality

and impact of a medicine, there's no signal to the system to have a look

at a medicine and consider,

"Is there something here that we should be looking at?"

Thank you so much.

I accept we cannot develop new drugs without

industry coming into contact with doctors and patients,

but they're still influencing prescribing.

Buying doctors sandwiches - it's not good.

And even a sandwich changing hands, I think...

I think we can avoid that.

I think we can just get rid of the sandwiches.

But the only way I can make that happen at Churchill is by persuading

the partners to stop taking the lunches.

I'm really amazed, I guess,

that you have drugs company-sponsored lunches.

-Why?

-I guess maybe it feels like we're at a point in medicine

where we know it's bad, and it doesn't square with anything else

that I've seen in this practice.

I mean, If I take you back to when we first met you, you know,

you wanted to get everyone together, so what did you do?

I bought you all sandwiches.

Absolutely, because if there's one way you can get people together

it's provide something that makes it worth their coming.

Well, maybe I'm no better, but to turn that on its head,

the person who should be criticised here is you

for accepting my sandwiches, because it is a bribe.

When I first started, I had an offer of a conference in a ski resort

that was basically a ski holiday. So, we've gone from there

-to once a month having a couple of sandwiches.

-OK.

We're constantly sent leaflets and invites to evening meetings

at very nice restaurants.

'The doctors only take the lunches,

'and they're adamant it doesn't affect their prescribing.'

The problem is that's what all doctors say, isn't it?

We all go, "Well, I'll eat the sandwiches,

"but I'll plug my ears for the talk."

But we know that that isn't what happens.

Sometimes you don't look at things.

-Yeah.

-So you're just used to doing things in a certain way...

-I get it.

-..and it takes someone external to come in and say,

"Have you thought about...?"

'I hadn't understood how much...

'they turned down.'

And all my kind of anger and outrage is probably a bit misplaced.

However, we will make Churchill

a pharmaceutical industry-free practice.

Following our meeting, the partners decide not to accept

drug company lunches any more.

It's a small victory, but my ultimate mission

is to get as many people as possible off drugs.

-Chris.

-I soon have a patient at my no-drugs clinic who presents me

with an excellent opportunity to do that.

I was told that there are alternatives to taking

the medication for things like blood pressure, diabetes,

so I'm quite interested in that.

'69-year-old Mike is taking ten tablets a day.'

So you are rattling, aren't you?

-Yeah.

-Are you a well person or are you an ill person?

Yeah, I do keep fit. I do two stamina swims a week.

You're a fit man. We're just giving...

I mean, look...

There is something really weird about this pile of pills for someone

who is well, who's never had a stroke and never had a heart attack.

It's all about preventing stuff.

'Mike's pills are for high blood 'pressure, high cholesterol

'and type 2 diabetes, but I don't consider these diseases -

'they're simply conditions that put him

'at an increased risk of having a heart attack or a stroke.'

Do you get side effects from any of the tablets?

You do. You get quite a dry mouth,

and certainly pain in the eyes.

Now, the pain in the eyes comes from...

..the blood pressure one.

Do you want to take all the tablets?

No. I don't want to take any.

-Great to see you.

-Chris, all the best.

-I'll see you soon, Mike.

There's no way that we like taking pills and you're thinking,

"Oh, not another one. When's it going to end? Or is this it?

"Is this what it's all about when you get old?"

Mike's drugs are the most prescribed drugs in the country.

NHS guidelines prompt doctors

to put millions of people on these sorts of pills.

It's a big issue and I need advice on how to approach it.

Professor Sir Muir Gray used to be Chief Knowledge Officer of the NHS.

Raised levels of cholesterol, raised blood pressure levels.

You'll notice I'm not using the name of diseases.

Raised level of blood sugar, type 2 diabetes -

this is really where too much medicine has focused.

But what these people have got, in my view,

is they've got the problem of the modern environment,

they've got walking deficiency syndrome or hyper-sitting syndrome.

Muir thinks there's a simple way to treat these conditions

caused by modern life.

I would spend a lot more money on giving people support for exercise.

And particularly physical exercise, I think we as a medical profession

have completely underestimated,

and last year the Academy of Medical Royal Colleges,

which is a very august body,

produced a report called Exercise: The Miracle Cure.

I never thought I'd see that in my lifetime.

A lot of the doctors say, "But we do, we tell people to exercise

"and they come back a month later and they've done no exercise,

"so they have to have a pill."

Giving people supported programmes,

not just giving them a bit of information or a bit of paper,

giving people support can be as effective

or more effective than medication.

In our health care system, most patients are just told to exercise,

rather than supported through it.

I want to use Muir's advice to help patients like Mike

with a programme of supported activity.

I just have to figure out how.

Crystal's been slowly coming off her painkillers.

She's discovering how awful coming off opioids can be.

Day four. I have been on the loo

for pretty much most of the night.

Diarrhoea and insomnia are common withdrawal effects.

Feeling pain.

Feeling it even more in my upper body today,

but I'm guessing that's because I've not had much sleep.

I'm really struggling today.

I'm pretty hot at the moment, too.

Today really sucks.

Crystal will also need supported therapy if this is going to work,

and I've found something unusual for her to try.

-Crystal.

-Hey.

-Thanks for agreeing to meet me.

-That's OK, I'm glad you're here.

-You all right?

-I'm very shaky.

-You're looking a little shaky.

-Yeah.

-But you're going to be just fine, OK? Let's go.

The man I'm taking her to meet is an expert in pain.

Crystal, this is Dennis.

-Hi, I'm Dennis.

-Hi, nice to meet you.

Attention. Bow.

Dennis Ngo is a kung fu master who's been teaching for nearly 40 years.

Stretch your groin.

Keep your body upright.

So, the logic about why we chose this kind of kung fu

is because it's exercise, it's slow.

I think more than anything else, we all believe,

the team of people that have talked about you,

that this can get inside your head and deal with your body.

Yeah.

'Many martial arts aren't just about combat.

'They focus on breathing, posture,

'mindfulness, and they condition practitioners to deal with pain.'

Number one thing - don't tick off Dennis, OK?

Dennis will see Crystal privately for a few lessons

before she joins the class.

How much do you want to get out of this?

-Everything. I want... I really...

-Do you really want to?

-Yes.

We take someone like you and we build them up very slowly.

In...

I'm taking Crystal into uncharted territory.

There's no established scientific evidence that kung fu will work.

Oh, sh...!

I know, OK. Stay there. Come on.

But Dennis has a deep knowledge of the human body.

Gyrate it very slowly, the other side...

Oh, shit!

I need you to actually push a little bit through.

The one thing I need you to do is not to search for pain.

-A lot of people who have pain...

-Yeah.

-..they look for the pain

instead of allowing the pain to arrive.

So, allow the pain to arrive, if it does.

-OK.

-If it doesn't, be surprised, be happy.

-OK.

-OK?

-OK.

Look up, look up.

Keep your back straight. Look up. That's it.

-I am going to stretch your back.

-That feels great.

Crucially, I think Dennis will inspire Crystal to accept

that this will be a painful road to recovery.

-Good.

-It's good pain, it's good pain.

-It's very good, isn't it?

-Yep, it's great.

-He's the real deal, isn't he?

-He is.

He spoke more sense about pain than I think almost any doctor

-I've ever met.

-That's why I said I wanted to take him back with us!

I'm hopeful these classes will help Crystal.

But even if it works,

it is hard to imagine GPs adopting kung fu as a treatment plan.

However, I've come up with something simple that Churchill's doctors

might be able to use in place of a huge number of their prescriptions.

I've arranged to meet Mike and a group of others who are taking drugs

to lower their risk of heart attacks and strokes.

There are thousands of patients like them at the surgery,

and this group would like to stop.

Hi, everyone. Thank you for coming.

Sorry I'm late. Just as a straw poll,

how many people here have had side effects?

OK. So, six out of nine people.

So I have a treatment that will reduce your risk,

not just of having a heart attack or stroke,

it will also improve your mood,

it will reduce your risk of all kinds of cancers,

it is essentially a miracle cure and it is side effect-free.

-So, my proposition...

-What's the catch?

The catch is there is no catch.

It's literally a total win, OK?

So the proposition is... five times a week for 30 minutes,

we're going to go for a walk, a brisk walk.

What do you think?

There are a few slightly sceptical faces around the group.

I think we're going to have to see how this goes.

OK, right, I will lead on.

Keep up, everyone.

Come on.

'Something tells me this won't be a walk in the park.'

I just hope I've got the motivation to keep doing it.

It's commitment, it's fitting it into my lifestyle.

We can all step out the door and go for a walk,

but you sit in the chair instead, don't you,

cos there's no-one sort of making you do it.

They may not be so keen on walking now, but once they

experience the benefits, I hope they'll be converted.

Research has shown that walking regularly has astonishing

healing powers, from reducing obesity

to cutting the risk of cancer.

'I want to see what effect walking will have on the conditions

'they're taking drugs for, so we're measuring their blood pressure,

'their blood sugars and their weight.'

Patient number one, Michael.

Hello.

'I'll take these measurements again

'when they've done eight weeks of walking.

'We're also stopping a drug they've all been prescribed called a statin.

'It lowers cholesterol,

'and I want to see if walking can do the same job.'

This is the entire NHS budget.

Then you press the space bar.

'I'm being helped by Catherine,

'a senior nurse who manages their medication.'

Do you think we're going to be able to relieve your workload

a little bit by getting people walking?

Realistically?

-No.

-Why?

I've seen people can achieve great things with motivation,

but something happens in their life and they get off track.

These people get easily derailed.

I'm hoping the fact they'll be walking in a group and that

I'll be supporting them will make the difference.

Sarah's treatment of cold water swimming has shown me how

some patients need support to complete their therapy.

She struggled to go by herself,

so I arranged a swimming coach to help her.

I want to see how she's getting on.

It's just like the country.

-We are in the country.

-It is the country.

Sarah's now been swimming regularly for a month.

Thank you very much.

I tell you what, everyone else is in wet suits.

Yep.

-But not us.

-Nope.

-I haven't got depression,

I don't see why I can't have a wet suit.

Everyone else is wearing one.

That is not 19 degrees.

When Sarah first started,

she could barely swim 50 metres on her own.

Now she's training to swim kilometres.

Whoa!

So, you've come a really long way.

It's brilliant. I can't describe it, but it's lovely.

I find that if I do have a low

with anything or I'm having a particularly bad day,

I find that if I come here, it solves it straight away.

-Really?

-Yeah.

Up the stairs, darling.

'I'm hoping the swimming has been a catalyst for positive changes in her life.'

Hello.

'The last time I came here, Sarah's house was full of clutter.

'A lot of it belonged to her brother who died just over a year ago.'

Look at this!

I mean, wow.

Right? So, last time I was here, you could hardly get around the bed.

This is like a different room.

It's really nice. You're in the room with someone who's

got a kind of organised life and organised head,

and someone who's got their act together.

Yeah. That's how I feel.

'She's now working with her GP to wean herself off her antidepressants.'

I'm on 20mg now, and...

Hold on, and you were on 40.

-I was on 40.

-So you've halved?

-Yep.

-OK.

Yeah, I feel a lot more energetic, it's nice to feel a little more...

me.

Evie, how's Mum been?

Yeah. We've been all good, isn't it?

'Sarah's still got some work to do,

'but she's now on the right track to getting off

'the antidepressants for good.'

In Sarah's case, lasting happiness

is going to come from exercise, diet,

friendships, her job, the way she's bringing up Evie, her relationship.

That is what you can't put in a pill, and that,

I think in Sarah's case, is what the drug was stopping her doing.

With Sarah doing so well, I want to see how Crystal's getting on.

12 weeks ago, her chronic pain left her barely able to move,

despite taking 30 pills a day.

I've adopted a radical approach to get her exercising - kung fu.

There is no good treatment for chronic pain,

so if we've made a dent in it and at least she's not on

pills that she hates and were causing her side effects,

that will be good.

I'm nervous.

This is the first time I've seen her in over two months.

Oh, my God.

She's standing on one leg.

She's smiling.

She's laughing.

Look.

She's moving. I haven't seen her wince or hold her back or...

Hello.

How are you? I'm sorry, I'm smelly and sweaty now.

Look, look, look.

So, I was just watching you the last little bit from outside the door.

I'm completely blown away.

Cool. Well, I've worked bloody hard, to be honest, to get here,

and Dennis is a pretty good drill sergeant.

-How has it been?

-I've been very, very proud of her.

Very. She wanted it.

Honestly, she wanted it.

No-one can get her to do what she does if they're not ready.

And she really wanted it.

-You know, I'm very...

-I feel like a good student.

-I'm very proud of you.

-Thank you so much.

Much appreciated.

It's learning to stand, learning to walk. Even the slightest thing,

you know, Dennis will come round and say, "Your head's not straight,"

and do that, and I don't even notice cos it's what we're used to.

So it's been good. Don't get me wrong, I have bad days still,

but not like I had before.

I just think you are the poster girl for what harm drugs can do

and how there are other things you can do apart from taking pills.

-No pressure.

-Give me a big old hug.

-Thank you. Sweaty hands.

Dennis, give me a hug.

Crystal's transformation shows that exercise

really can be a miracle cure.

It benefits the whole body, from the brain to the bones,

enhancing its ability to heal itself.

But bringing this miracle to my walkers is proving hard.

So, is this normal, that it's just two people?

Well, it has been for the past three nights.

This is a disaster.

It is.

Hi, is that Sophie?

It's Chris here. I know you're not being lazy...

'I'm determined to make sure the group gets the support

'it needs to thrive.'

Spiky!

'This walking programme could easily be rolled out at the surgery.'

Spike, my mother-in-law's dog.

'Thousands of their patients are on medication to lower their risks

'of heart attacks and strokes.'

That's no way to say hello.

That's it. Once he gets going, there's a lot of momentum.

'But I've got to keep my test group walking regularly

'so I can demonstrate the benefits.'

You're going a bit faster.

'Five walks a week, 30 minutes a day is all it takes.'

Two miles. Pace, 15.37.

My pain in my leg's gone, though.

-Has it?

-When I used to kneel down, I could never get up,

but it's gone now, I can't believe it.

What I said at the beginning of this - walking is a miracle cure.

They're certainly feeling the benefits,

but has the walking lowered their risks of heart attacks?

Michael Smith?

The eight-week experiment is over.

-Ouch.

-There's always one.

-Come in, have a seat.

-Before the group started walking, they had

their baseline measurements taken for various conditions they have...

Mummy's big and brave.

..from type 2 diabetes to high blood pressure.

They even stopped taking their statins so we could measure

the effect the walking had on their cholesterol levels.

I'm nervous about the results.

-Hi, Catherine.

-Hi, Chris.

-You got something for me?

-I've got the results.

Lordy, lordy.

'It's good news.

'The blood sugar levels of the walkers with type 2 diabetes

'have changed dramatically.'

His HbA1c...

This is the measurement of how good his diabetes has been

over the last few weeks. It's now 57 from 75.

-That's fantastic.

-I mean, that...

Is that a good result? You see this the whole time.

-Yeah.

-Is it?

-Absolutely.

-Oh, I'm so...

-I'm very pleased with that.

'It's an effect seen across all the diabetic walkers.'

Her HbA1c has gone from 56..

..to 48,

and 48 is kind of the sort of minimum that gets you

to be called a diabetic,

so actually she's starting to come toward,

you know, stopping being diabetic.

And that's in eight weeks.

Which is really significant.

It's better than some of the new drugs say they can do

in a few months, isn't it?

Not only that, the walkers' blood pressures dropped, they lost weight,

and even their scores in mood tests soared.

37 to 51.

That's massive.

I mean, that is massive.

If the group keep this up, there's a chance they'll be able to cut out

the drugs they're taking altogether.

Now they feel the benefits, they're motivated to carry on.

And even though their cholesterol levels remain high,

none want to start taking their statins again,

preferring to try and lower their levels naturally.

But Mike has the highest risk of having a heart attack,

and taking a statin again is the quickest way to reduce it.

So, this is quite an interesting chat that we've got to have.

You are at a level of risk where I start to go,

"Maybe I would take a statin."

You have reduced your risk by losing weight. You have reduced your risk

with blood pressure. But your absolute risk is still high.

Well, what comes to my mind is...

Let me do a three-month trial,

then do another blood test and see what the results are.

So, when you've got the opportunity to come off a pill,

it's like coming out of prison, you know, you've been released,

you're feeling different in your mind, a bit younger.

'I decide to take what I've found to the doctors.

'I hope they'll be as impressed as I am by the blood test results.'

-So, you guys don't know the results?

-We don't know, no.

Mike, I guess, had the biggest result where his HbA1c

went from 75 to just over 50.

That level of reduction, that's quite impressive.

That is good.

We don't always get results like that with drugs as well.

-Did they lose weight?

-Every single person lost weight, yes.

Walking as treatment for diabetes, as a way of reducing your risk of

strokes, heart attacks and death suddenly starts to feel like,

-"Oh, that's really good."

-If, within the practice, we have,

you know, a diabetic walking group set up,

to me that's absolutely fantastic.

-Really?

-It's something the practice should be supporting.

I'm so pleased that they feel it did pay off.

I mean, imagine if GPs all over the country were able

to support patients like this. You know, we'd see reductions

in medications for blood pressure and cholesterol and diabetes.

But I think there's something much more important than that,

that we really saw with Mike and Janet, particularly,

all these things it's hard to measure - their mood improved,

they slept better at night, they felt like they were in charge

of their own health and their own bodies.

You can't put that in a pill.

I'm at the end of my time here,

and I now realise the real problem isn't simply the drugs

but our health care system itself.

We hand out pills when often we should be supporting people

through drug-free alternatives instead.

If you say, "I want to go walking," your doctor says,

"Well, go walking," and that is it.

Where's the support? We all know that we won't do it.

The "health service",

if it is to be a health service and not a drug prescription service,

needs to be able to support people doing those difficult, long-term,

but ultimately massively rewarding and health-giving things.

In just a few months, I've witnessed extraordinary transformations...

..as my patients have turned their backs on drugs.

If we can empower doctors across the country to help millions

of patients do the same thing then, in the future,

prescriptions could mean something much more powerful

than just pills.