Randomised controlled trials (RCTs) of patients with dementia or mild cognitive impairment demonstrated better cognitive scores after 6 to 12 months of exercise compared to sedentary controls. A RCT of older adults found that 1 year of aerobic exercise was associated with significantly larger hippocampal volumes and better spatial memory; and ‘other RCTs in seniors documented attenuation of age-related gray matter volume loss with aerobic exercise’ (Ahlskog et al, 2011). Exercise, the authors concluded, ‘should not be overlooked as an important therapeutic strategy’ (Ahlskog et al, 2011).
In a Spanish study of 1709 adults (mean age 72 years), Navarette-Villanueva et al (2021) highlighted ‘the importance of fitness in older adults, as it is at least as important as the avoidance of accumulation of excess fat with respect to the consumption of a smaller number of medicines.’
And most recently, Ede (2024) addresses the challenge of drug medication treatment resistance among those with mental illness by investigating ‘metabolic psychiatry’ a term coined by Stanford University psychiatrist Dr Shebani Sethi, who defines it as ‘a new subspecialty focused on targeting and treating metabolic dysfunction to improve mental health outcomes’ (Ede, 2024).
The three examples above (from many available) invite the inference that the question ‘Are drugs necessary?’ is not an entirely facetious one. As the broadcaster and author Clive James noted: ‘The power of science is to transform the world in ways that not even scientists can predict’ (James, 2007: 117). Thus, the widely dispersed – and accepted – cultural meme of there being ‘a pill for everything’ is deservedly under scrutiny and challenge, with Holstein (2004) considering the phrase in the context of enhancement technologies: ‘those “drugs and procedures” that doctors use “not just to control illness, but also to improve human capacities or characteristics”’.
Pharmacist Graham Phillips reported in 2014 that ‘12–15% of hospital admissions are directly related to prescribed drugs’, and he attributed around half of these admissions to ‘complex interactions between a cocktail of prescribed drugs, administered in response to a plethora of concurrent disease states’ (Phillips, 2014). He observes that the remaining 50% of medicines-related admissions are down to poor compliance and asserts that ‘patients with long-term conditions are reluctant to take medicines that will help control their condition and, ultimately, improve and extend their lives.’
A decade later, Phillips (2024) has found no improvement: ‘The NHS acknowledges that overprescribing is widespread … The number of prescriptions per head of population doubled from 10 per head in 1996 to 20 in 2016, and adverse drug reactions are responsible for as many as 20% of hospitalisations.’ So it's no surprise that after 35 years of practising community pharmacy, Phillips found himself questioning the ‘pill for everything’ approach, and founded ProLongevity (www.prolongevity.co.uk), a UK-based programme dedicated to applying precision nutrition and lifestyle coaching to prevent or reverse life-limiting conditions like type 2 diabetes (T2D) and dementia.
Another aspect indicative of a move away from the ‘pill for everything’ paradigm is the non-pharmacological option of social prescribing. Taylor et al (2019) adduce evidence suggesting that ‘socioeconomic factors can have the greatest effect on health and wellbeing, accounting for 40% of all influences on the individual’, with additional factors including social isolation, bereavement, and debt. The implication, suggest Taylor et al (2019), is that clinical services may be inappropriate for individuals whose conditions may well have a non-clinical cause. The corollary of this is that addressing the underlying causes will be more effective than resorting to the ‘pill for everything’. In addition, ‘GPs in England reported spending 20% of their time dealing with non-health related matters such as relationship issues and housing, providing further evidence why dealing with these factors via social prescribing has been viewed as an option to decrease GP's time spent on non-medical issues’ (Taylor et al, 2019).
However, in their survey of 120 respondents (94.6% pharmacists and 5.4% pharmacy technicians), although Taylor et al (2019) reported ‘a lack of knowledge and experience with social prescribing … there was enthusiasm for pharmacists and the wider pharmacy team to be involved in local social prescribing pathways.’
With mounting peer-reviewed evidence showing that lifestyle changes are superior in many instances over medication in addressing conditions like T2D, it is perhaps time to recognise that non-pharmacological interventions should first be considered before reaching for the prescription pad.