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He was a visitor to my pharmacy only a few unpredictable times a year. His name was Mr Paradine. He was fiftyish and a human dynamo. One autumn, Mr Paradine got bronchitis. It was not serious and cleared up with
a course of amoxicillin. But the doctor found something of much greater
concern: Mr Paradine’s blood pressure was high. He was
prescribed heavyweight antihypertensives and told to return in two weeks.
When Mr Paradine came back two weeks later with a repeat
prescription, he was not the man I knew. A hunched, pale-faced
character was leaning against the counter. In a quavering voice and with
a hangdog expression, he said: “The doctor’s very pleased
with me.”
I muttered some platitude and retired to the dispensary to contemplate
a man cut down in his prime by medication. It was the first dent in my
belief in the age of therapeutics.
I began to refresh my knowledge of hypertension. I found
that it was true that large scale trials showed that reducing the diastolic
pressure
of hypertensive patients to below 90mmHg gave the treated individuals
a few years more life than those who were untreated. On average those
with a lowered blood pressure lived three to four years longer. Doctors,
the medical establishment decided, had no choice: the BP of
hypertensive patients must be reduced to what was now decreed the norm.
In the trials I studied, no mention was made of quality of
life. Modern medical opinion seems to have overlooked the fact that BP
rises
with age to compensate for the body slowing down. Reducing it to prolong
life by a few years should not be undertaken without considering the
effect on the patients and explaining the pros and cons to him or her.
I retired early from pharmacy to write shortly after encountering the “cured” Mr
Paradine. I can see now that the experience influenced my decision to
leave community practice. I began to revise my hitherto naive acceptance
that
each new and more expensive drug was an
improvement on the one before and to see that to some extent I had been
influenced by the welcome additions to my income that the new drugs effected.
Even the newest drugs, I realised, still worked like a shotgun, hitting
the intended target but affecting other body parts and processes to their
detriment.
My more sceptical approach to new drugs was enhanced by news
of Mr Paradine, who lingered palely on. Had he not developed bronchitis
and had his BP
taken, he would have continued to be the dynamic Mr Paradine who energised
all with whom he came in contact. Perhaps he would have enjoyed three
or four fewer years than the person he became on medication, but he would
have continued to be the spirited character he was intended to be.
— Contributed
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The Pharmaceutical Journal