Social prescribing comes of age

Social prescribing represents a steep learning curve for many doctors says Craig Sams, but it’s rocketing up the agenda

The setting: a GP surgery. Receptionist: “The doctor will see you now.” Doctor: “Hi, how are you getting on with your low-carb diet? Are you getting the regular exercise we agreed? Can we de-prescribe the Metformin? Let’s do a few tests to see whether you’re ready to come off the drugs. By the way, how are you getting on with your cookery classes? Let’s see if we can finally wave type 2 diabetes goodbye.”

Bad news for the pharmaceutical industry but ‘social prescribing’ is on a roll and there will be a lot more of it in the future. Professor Tony Avery, the NHS National Clinical Prescribing director has said the aim is to bring about a ‘culture change’. He sees social prescribing as transforming modern healthcare, saving money and improving people’s lives. Not only that, but adverse reactions to medication are estimated to cost NHS England over £2 billion a year (not to mention the impact on people’s lives and health). The number of disability claimants doubled from 2021 to 2022. 8.3 million Britons are now on antidepressants.

The College of Medicine’s Beyond Pills Campaign is pushing hard to stop the overprescribing of medicines. The college says that 1.1 billion medicines are prescribed unnecessarily. Its chair Michael Dixon (medical advisor to King Charles), has said ‘Medicine…is no longer affordable or sustainable. A new medical mindset is needed which goes to the heart of true healthcare.”

Back in the 1930s an experiment in social prescribing called the Peckham Experiment engaged with 950 local families to get them on the track to health. They had a gym, a swimming pool, cookery classes, a vegetable garden and workshops about health. Members would have a medical health check once a year and were monitored on a regular basis. The kids did better at school, marriages were more stable and women were empowered (knitting groups helped with this). Social and community activities were organised by the members and helped reduce isolation, loneliness and alienation, illness levels fell dramatically. William Beveridge who drafted the plan for the NHS, was impressed and envisaged similar health centres up and down the country. When the Government put his plan to the British Medical Association in 1948 they were not impressed and the Government was forced to back down and agree that all ‘health services’ would solely be via the GP’s surgery. The Peckham Experiment closed down two years later.

But social prescribing is finally rocketing up the agenda. There are now 15 Pain Cafes in Cornwall helping people manage pain without painkillers, relying instead on exercise and psychological support. Dependency on antidepressants has been shown to cause more harm than good (as anyone who watches Happy Valley already knows). Time to kick the diazepam.

Increasing awareness of the benefits of phytonutrients (the kind of stuff the health food industry has been emphasising for decades) is filtering through to the medical industry and impacting on social prescribing. It was the Dutch philosopher Desiderius Erasmus who famously said 500 years ago: “Prevention is better than cure.” With life expectancy rates going backwards, increasing rates of alcohol and drug-related deaths and hospitalisations, along with record levels of obesity, social prescribing is happening just in time. Will people be taking their prescriptions into the health food store? Or will the pharmacies try to capture this newly lucrative business?

The Bromley by Bow Centre in East London is pioneering the ‘new’ approach to health and wellbeing, and it is a model that is being emulated in more and more places.

Yes, the first reaction is ‘I told you so’ - but the fact is that these people are serious. At least so far.

How long will it be before doctors prescribe yoga and pilates classes or give out free prescriptions for herbal medicines and supplements? Will you get free cookery classes on the NHS?

There’s still a long way to go, but at least the direction of travel has finally changed. The Government has just allocated £50 million to support 42 Integrated Care Boards across the country to help doctors to ‘de-prescribe’ their patients and get them on the path to wellness without drugs. There will need to be proper support for the medical profession - they know it makes sense but it’s a steep learning curve for many doctors. They didn’t teach this kind of stuff at medical school.

V&A Keynote Speech

The V&A 'Revolution - Records and Rebels 1966-1970) exhibition closed earlier in 2017.  I was invited to give the keynote speech at the launch dinner at the museum.  It was well received.  Here's the text:

While staying in a Sikh temple in Delhi in April 1965 a couple of guys from San Francisco gifted me with a 1000 microgram capsule of Sandoz pharmaceutical grade LSD.  I took my first trip in September of 1965, 51 years ago almost to the day.  Then I went back to complete my final year at the Wharton School of Business at the University of Pennsylvania.   In October Timothy Leary came to Philadelphia with his message to explore higher consciousness.  This created a psychedelic community, as happened wherever Leary went.

The American Medical Association described the diet as ‘the Hippie diet leading to death.’  My restaurant opened in February 1967 and one of my first customers was Yoko Ono, who had been working at the Paradox when I had visited a year earlier

People got religion – not the old guy in the sky variety, but the personal spiritual discovery embodied in yoga and meditation and Zen Buddhism.

Our clothes helped us identify each other.  I imported coats I’d seen in Afghanistan a year earlier.  The Beatles bought some at Granny Takes a Trip boutique on the Kings Road and set off a global craze.  I also imported Tunisian kaftans, Tibetan shoulder bags and Chinese silks that Aedan Kelly would dye with blobby designs that were then tailored into shirts and dresses.

Clothes also helped the police to identify us and they started randomly searching and arresting people who looked colourful or had long hair.  We understood what it was like to be black and this fuelled empathy for civil rights as well as for drug law reform.

We believed in the power of peace and love.  The Vietnam war was at its peak – we tried to stop it and faced up to the full force of the law in Grosvenor Square, Chicago and Kent State.

We experienced nature and the environment on an intuitive and empathetic level, seeking out green places like Golden Gate Park or Kensington Gardens.  We read the romantic poetry of Keats and Blake, deploring dark satanic mills.

When the Move sang “I Can Hear The Grass Grow’ or The Small Faces sang ‘It’s All Too Beautiful’  we responded viscerally.   Then the Beatles summed it all up as “All you Need is Love.”

Greenpeace and Friends of the Earth both were born out of this awareness of our oneness with our beautiful planet.

We got sexy.  It was hard to repress sexuality when all your other senses were heightened, so if you were gay you let yourself go, if you were polyamorous you started to swing. Sexual experimentation led to sexual liberation.

We were a community – with a strong sense of communalism.  Not communism, quit the opposite: we didn’t trust the State but we did form communes. Our individualism, communalism and libertinism combined to forge a political libertarianism.

It wasn’t easy to get a job if you dressed like a hippie and had long hair, so many set up their own businesses. Fashion, publishing, natural foods and music were areas where entrepreneurial spirits could follow their heart and make a good living.

Our goal was to create an alternative society, an exemplar of how life could be and should be.

We underestimated the degree to which the legacy industries that profit from war, environmental degradation, ill health and financial manipulation would still control the agenda 50 years later.

This exhibition captures magnificently the deep spiritual, philosophical and political intent of those times and their impact on the world today.

It could help to accelerate the change of which we dreamed.

Perhaps it will help us to build Blake’s hippie vision of a new Jerusalem in this green and pleasant land.

Cheer up, we just reversed humanity’s decline

OK, reversing humanity’s decline took 40 or 50 years longer than we thought. But let’s celebrate it anyway, writes Craig Sams

Could this be the Big Lifestyle Turnaround that we’ve been dreaming about and waiting for?

Every year for decades there has been an annual increase in new cases of Type 2 diabetes, which correlates with comparable figures for obesity, which is a factor in cancer and heart disease. That’s the bad news. What’s the good news?

Over the last 6 years (averaged to avoid ‘blips’) research shows there has been a significant DECLINE in incidence of diabetes in the US. Diabetes is still happening, but less and less each year. That means that, going forward, there will likely be less cancer, less obesity and less heart disease. The endless upward graph is going into a downturn.

The researchers, at the US Governments Centers for Disease Control and Prevention (CDC), took a shot at what might be behind this encouraging news. Their studied conclusion? People are more health conscious than hitherto and this is reflected in healthy and informed food choices and greater commitment to regular exercise and bodywork, including yoga and pilates. In other words, the message of healthy living is getting through. More people than ever are shopping at natural food stores or Whole Foods Market. Supermarkets are giving more and more space to organic and healthy foods. We’ve always said that this could happen and now the evidence is in that a healthy lifestyle prevents degenerative disease.

So where does that put Coca Cola? Their sales are down in the US, with the international market also weakening.

And MacDonalds? For seven straight quarters up to the middle of last year, their sales have been dropping with no evidence of a turnaround. Big Macs and Coke once seemed invincible – the obesity epidemic and resulting diabetes soared in parallel with their sales. Now their growth has stalled.

So where is the money going? Last year yoga and pilates studios in the US had sales of $9 billion, up 7.5% year on year. There are 30,000 businesses employing 95,000 people, about three per business. It’s a horde of small enterprises that are capturing people’s longing for physical wellbeing, core strength and flexibility. The yoga bunnies and pilates enthusiasts are alive to nutrition, healthy eating, the gut microbiome and anything else that points them towards a longer, healthier and happier life. There’s little opportunity for scale in this market – there are a few big gym chains but most of this healthy stuff is run by sole practitioners or a small local group that might also include nutritional advice, massage and counseling. In the caring, sharing economy of the future there is a lot more peer-to-peer and a lot less corporate-to-consumer relationship.

It’s not going to be easy to get humankind back on track, though.

The junk food decades from the 1950s to the 2000s meant that a lot of kids were born who inherited the epigenetic legacy of their parents’ poor diet and environment. We know that what you eat affects your health – now we also know it affects your genes and is an undesirable legacy to your children. I won’t go into the detail of DNA methylation and transfer RNAs, but suffice to say that if a father or a mother eats too much sugary and industrial food and is exposed to environmental contaminants such as pesticides, food colouring and preservatives their baby’s start in life is clouded and the kid is more likely to suffer impaired insulin tolerance that could lead to diabetes. The good news is that epigenetics cuts both ways. A lot of the crap that used to screw up our genes is now out of the system – things like DDT, lead, hydrogenated fat, toxic dyes and preservatives and high levels of pesticide, fungicide and herbicide residues in our food are all non-existent or much lower. So going forward we could be passing on healthier and more robust genes.

When we launched Yin-Yang Ltd, the macrobiotic food company that would morph into Whole Earth, Vegeburger and Green & Black’s, we thought the healthy eating revolution would be over by the early 1970s. It was so obvious. We naively thought everyone would go for it – after all, who didn’t want to live a long and healthy life? As my brother Gregory said, we were looking at the future through the wrong end of the telescope. We saw the future, we were just out by 40 or 50 years. Boo-hoo about the ruined lives along the way, but hip hip hurrah for the coming reversal of humanity’s decline.