Mother’s Little Helper?

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During the Christmas break I read an article in The Independent about an increase in the number of “Valium addicts” being created by GPs and it stated

“Doctors are being sued for creating prescription drug addicts amid claims they have failed to follow safety guidelines published more than 20 years ago”

The number of clinical negligence claims is said to be increasing, from people who have been prescribed benzodiazepine drugs (which include diazepam/valium and lorazepam/ativan) for long periods of time and who have suffered injury and illness when coming off them.  The report suggests that GPs are still prescribing the drugs and quotes a Professor Malcolm Lader who believes there is a link between long-term tranquiliser use and brain damage as saying the Royal College of GPs is in denial about the issue.

This got me thinking on several levels.  The first was a reminder that when I was an articled clerk (ie trainee solicitor) back in 1991-93, I was told by my firm to “look after” the ten or so (legally aided) clients we had who were involved in the Benzodiazepine (BDZ) litigation which, at the time, was the biggest class action ever seen in the UK. The central thrust of the claims was that the drug companies should have known, or did know but didn’t act on the knowledge that long term prescription of BDZs could lead to injury. I don’t recall doctors being named as Defendants. It was frustrating work because all the exciting legal and medical stuff was done by the lead firms and my High Street firm acted as little more than a remote outpost, receiving instructions in the monthly bulletins from the lead firms, instructing the medical experts on the recommended lists and waiting for the inevitable outcome, which was collapse of the whole litigation after about three years.

Looking back it was obvious that the Plaintiffs, as they were then known in those long ago days pre-Woolf, would fail on the issue of causation.  In essence our clients, all of whom had (as far as I can recall now 20 years on) fairly nasty and intractable mental health issues anyway and it wasn’t possible to prove that the quality of their lives would have been much better without the drugs. Are we about to see a re-run of that litigation and that outcome?

In the first instance the potential defendants are different – last time it was the drug companies and this time the people prescribing the drugs who, surely, really should know better following the previous litigation? Breach of duty of care shouldn’t be much of an issue, but I suspect causation will be … again.

The story also got me thinking about the bigger scandal, which is the complete lack of meaningful assistance for people suffering from mental illness.  I’ve acted over the years in both personal injury and employment cases for many people suffering from mental illness and have seen the effects personally to me at close quarters. Doctors seem to have a very limited arsenal of tools with which to treat what is a massive problem in the UK.  They seem to have a wide variety of drugs to hand over (SSRIs, MAOI, TCAs etc) but trying to find a treatment other than a “mother’s little helper” is much harder.  Most of these drugs seem to take ages to work, give horrible side-effects when being taken and don’t do anything to cure the underlying problem.  That seems to be the task of so-called “talking therapies”, but try finding your way through the maze of counsellors and psychologists and any other number of “therapists” offering this or that “method” and it may lead you to the point of madness anyway. Even if you find someone, how do you know they are competent and won’t cause more harm than good? You might expect the overstretched NHS to struggle to offer anything, but do the big charities offer anything better?  Trying to find a support group for someone suffering from acute anxiety seems virtually impossible, for example.

Talking therapies are supposed to be much more successful in curing mental illness but it seems from what I have seen to be a neglected area.  Taking another pill instead is easy – it takes away the crisis but not the long term underlying cause.  I have some sympathy for overstretched GPs who can only spare 5 minutes with each patient at maximum.  Perhaps the NHS should spend some of the many millions it undoubtedly spends on anti-depressant drugs on developing and regulating the “talking therapy” sector, perhaps in conjunction with the relevant charities.  Will it take a potentially massive litigation against the NHS in the form of another BDZ class action to cause public policy to change?

The third thought I had on the issue was that back then most of the Claimants were funded by legal aid.  That won’t happen this time.  The participants will all be signed up on No Win No Fee agreements, backed by insurance (if the ATE industry will support it) meaning that if it collapses again it won’t be the taxpayer footing the bill. Undoubtedly many deserving Claimants won’t be able to seek redress.

None of this is new of course.  The Rolling Stones sang about it over 45 years ago;

“Kids are different today, I hear ev’ry mother say
Mother needs something today to calm her down
And though she’s not really ill, there’s a little yellow pill
She goes running for the shelter of a mother’s little helper
And it helps her on her way, gets her through her busy day”

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