If you pack in the pills you may fall on more than hard times

NOT feeling great this Monday morning, are you? Bit of a sore throat and a runny nose?

With luck, you’ll be miserable for a few days and then recover.

Of course, if you’re really lucky, you have no symptoms at all. You have no infection at all. Now, admittedly, your health check some time ago did reveal that you have raised blood pressure, or cholesterol, or a wee touch of osteoporosis, but the great thing about those ailments is that even if you have one or more of them, you are likely to be asymptomatic. Raised blood pressure or cholesterol don’t give you headaches, a sore throat or make you fall over. Neither does osteoporosis.

And, while you may be coming near to the end of the current blister pack of recommended tablets, unless the medicine you’ve been taking is paid for by the State, there’s a good chance that you may not go to the pharmacist to renew them.

If you’re under financial pressure and trying to cope on radically reduced money, you may go into Prescription Postponement. In other words, you’ll say to yourself: “I really don’t believe I’m going to have a heart attack or a stroke or a fall. Not immediately. So, just for a while, I’ll skip the tablets. Never took them that regularly, anyway.”

All around this country at the moment, this is happening. People are postponing compliance with the medical regimen recommended by their doctor. They’re saving money and the only people who are suffering are the manufacturers of the drugs and – marginally – the pharmacists who would expect to dispense them.

Of course, a couple of years down the road, things may be very different. Your untreated cholesterol and high blood pressure may drop you where you stand with a heart attack or stroke. You may survive. You may not.

If you survive, you may be permanently disabled and require full-time medical care. Similarly, your untreated osteoporosis may mean that the day you trip over your cat, you may end up with a broken hip and all of the nasty sequelae broken hips that tends to generate.

This country, courtesy of the recession, has embarked on its biggest unplanned medical experiment since the Second World War. The nation has neither the money nor the mechanisms to monitor and measure the outcomes, and it’s extremely doubtful that it will have the money and facilities to cope with the long-term consequences.

The end of World War II, as Fine Gael health spokesman Dr James Reilly recently reminded us, brought about the National Health Service. The British, standing – literally – in the wreckage of that conflict, set out to build a health service which would be the envy of the world and would treat people because they needed treatment, not because they could pay for treatment.

But even before the NHS was dreamed up, the war had delivered an important health message, courtesy of rationing. Awful thing, rationing. You could no longer just go to your local shop to buy rashers and eggs and butter. Instead, you got your little ration card, which entitled you to buy only a set amount of what was available. Based on what you needed.

That was the important bit: based on what you needed. The British authorities made out a list, grounded in the health research available at the time, which established that everybody, but particularly children, needed a minimum level of some nutrients in order to survive and thrive. So the rationing system took those nutrients into account, sometimes delivering them in ways the children of the time hated, like cod-liver oil.

The end result was a generation of kids without rickets. A generation of Britons markedly healthier than if the war had never happened. (A weird gain, like the fact that some hospitals in the North developed world class skills in the management of blunt force trauma, because they had to treat bomb-blast victims during the years of the Troubles.)

THIS recession has a very different kettle of consequences lining up behind it. It may not last a decade. It may not even last five years. But the indications are that people whose pensions have been wiped out or severely reduced will not recover their financial equilibrium for many, many years. If a sizeable proportion of them manage this devastation by a cluster of actions which include prescription postponement, it will present the most fascinating change in patient behaviour in decades. It will be like an enormous national clinical trial of many major drugs.

It may also create an unanticipated bulge of acute need for the health system from 2020 onward. It could do that thanks to just one of the problems mentioned earlier: osteoporosis.

The HSE, the National Council for Ageing and Older People and the Department of Health and Children last year published its Strategy to Prevent Falls and Fractures in Ireland’s Ageing Population. Correction. They didn’t quite publish it. They printed it and let it escape.

The only reason I have a copy is that one of the experts who put it together is a consultant geriatrician named Dr Miriam Casey, based at St James Hospital. Dr Casey, who served on the osteoporosis sub-group, has a bee in her bonnet the size of a seagull about preventing bone-rot (not that she calls it bone-rot) and falls.

It’s really very simple. If you’re 25 and you eat lots of dairy food and drink milk, then if you fall over the cat, there’s a good chance you’ll end up bruised and furious, but unbroken. Even if you had a fair turn of speed going when the cat – as cats are programmed to do – went crossways in your path, so that you DID break a bone, it won’t kill you and it will heal pretty quickly thereafter.

If, on the other hand, you’re heading for 60 or are older and have spent most of your life drinking caffeine-rich drinks like Diet Coke instead of milk, and if you’ve decided to economise on your calcium and Vitamin D, not to mention the prescription anti-osteoporosis medicine you’ve been prescribed, then, when you fall over the cat, your bones, chalk-like in their rottenness, may break.

If they do, you may die. No kidding. The Strategy to Prevent Falls and Fractures in Ireland’s Ageing Population has a scary graph, showing that deaths due to falls per 100,000 of people over 65 are as few as 13 per year in Spain. In Ireland? Sixty two. Irish people have more than four times the risk.

Even if you survive the broken hip, for example, your chances of a full and independent life are grievously impacted.

Twenty years from now, Ireland will have a million people in the 65-plus age group – including many who, right now, are economising on osteoporosis prescriptions.

The health service at the moment is under enormous pressure. The pressure it may come under from surviving heart attack, stroke and hip-fracture sufferers in the future is unimaginable.

Unless we keep taking the tablets.