Chief Medical Officer

Realistic Medicine: My first CMO Annual Report

January 20, 2016 by 12 Comments

Today I launched my first annual report as Chief Medical Officer  for Scotland .  There is an Executive Summary  and a short video where I introduce the report and its focus on ‘Realistic Medicine’ and what this can mean for the challenges that face us as a profession and in healthcare.

I believe that the profession, with doctors as collaborative leaders, as in so much of our history, can influence and be a driver for change.  My team have produced the infographic below which sets out the questions I want to ask doctors and for them to discuss with each other.

Please feel free to feedback to me by posting to the blog and reaching me via Twitter and LinkedIn.  I look forward very much to hearing your views.


  • Mark Parsons says:

    An excellent well thought out and comprehensive document that, if recognised as such by all politicians in this country, would set us on a pathway to the recovery of sense and reason, rather than short term populism. Excellent well done gives me some confidence that someone with influence has wisdom and understanding – Mark – Cancer Pharmacist

  • Malcolm Maclean says:

    The WHO thinks that, generally speaking, the UK is Iodine deficient.
    Consider if you will, that Iodine deficiency is linked to a host of diseases.
    It would therefore appear that improving indices of health in Scotland is actually not all that complicated.
    However, the response from our leaders to serial suggestions over many years, that the UK is Iodine deficient, has been a deafening silence.
    That being the case, how can spokespersons on health possibly expect to be taken seriously?

  • Lorraine Cleaver says:

    Congratulations are due to Dr Calderwood for such a comprehensive and forward thinking report.

    My petition for improved Thyroid diagnosis and treatment has been ongoing at the Scottish Parliament for over three years. In that time, I have heard nothing but platitudes and affirmations of the status quo from Health Ministers. The fact that Thyroid Function Tests are based on poor quality evidence seems to trouble no one. Polypharmacy is rampant with thyroid patients and antidepressants are over prescribed, along with a large selection of other drugs, none of which help when the patient needs more thyroid hormones and more choice of thyroid hormones.

    Next Tuesday, the Minister for Public Health will attend the committee and I fully expect that she will rhyme off the party line, that the evidence base says this, that there isn’t enough evidence to do that, that the MHRA in England deal with the other. It helps no one. It fools no one.

    From the Association of Clinical Biochemistry 2006, Use of Thyroid Function Tests.
    Routine thyroid function testing has been available for more than thirty years.
    Therefore, it may seem surprising that the quality of evidence to support the
    recommendations in these guidelines is generally poor. The main reason for this
    finding is that the early studies that were used to assess the value, validity and
    effectiveness of thyroid function tests in a variety of clinical situations were
    performed before the requirements for evidence based medicine were adopted. There
    is a real need to conduct new studies that conform to the rules of evidence based
    medicine in order to provide answers to some common but contentious issues in the
    use of thyroid function testing. ”

    Ten years on, nothing has changed. It’s shameful. And it could just be linked to Scotland’s abysmal health record, particularly as our country is iodine deficient. I urge Dr Calderwood to grasp this nettle.

  • moira adams says:

    I have just read the new CMO’s Annual Report and have found her chapters on Realistic Medicine both refreshing and reassuring. I have long been a follower of H Gilbert Welsch et al who have been eschewing the dangers of creating patients needlessly in the headlong rush to test and screen.

    It is not only the elderly with the increased incidence of polypharmacy who are harmed by this enthusiastic approach but the general public who are continuously encouraged to attend for screening and testing for diseases which will never cause them harm in their lifetimes. The public have been sold the mantra that screening/testing is good and saves lives and it is now time that we caveat this advice with warnings about over-diagnosis and over-treatment.

    The NHS is a finite resource and it is counter-productive to direct scarce resources to the “worried well”rather than tackling the health inequalities which exist in our disadvantaged areas.

    This is not going to be an easy job as many will perceive this as a “cost-cutting” exercise – few will ask for the evidence on which this advice is based. But I believe the CMO’s report is a step in the right direction and must be promoted to all health professionals and the public at large. Well done for tackling a very pressing problem.

  • Marion Brown says:

    RE: Too much medication ….

    There is a summary of a recent BMA Board of Science analysis report within the link below:

    The full BMA Board of Science analysis report (October 2015) can be read at

  • Marion Brown says:

    I have become very concerned about the over-use of antidepressants, anti-anxiety and anti-psychotic medications. Please can I suggest this very useful free guide – as well as the videos on this link

  • Fiona French says:

    I very much welcome your report. I do believe that over-prescribing is a massive problem in general practice and it is not confined to patients with multiple health problems. Please see my website for my campaign on prescribed drug dependence.

    Patients are suffering horrendously from benzodiazepine withdrawal. It is not just the issue of being prescribed drugs, it is the issue of the trying to stop them. GPs seem to be unaware of the devastating effects of the drugs they prescribe which is astonishing,

    As a patient whose life has been devastated by prescription drugs I do believe it is time for the medical profession and the public to find a better way forward. This debate needs to involve the public as well as the profession. Keeping patients on drugs for decades, risking their health in the process, is not good medicine. Using the current crisis in general practice is not good enough, this is an issue that has been around for many many years.

    I was prescribed nitrazepam for myoclonic epilepsy in 1975. 40 years of depression and antidepressants ensued despite a letter from a neurologist in 1981 stating that nitrazepam could be making my depression worse. I lived a “half-life”. Advised to stop nitrazepam at age 59. Within one year all psychological and emotional problems had gone, nor did I have epilepsy. 40 years of feeling alone simply disappeared. There is no doubt those feelings were due to the drug.

    Sadly the withdrawal from nitrazepam has left me bedridden for over two years and I may not recover. I am physically disabled though psychologically well. I am meeting others online from across the UK also severely ill after withdrawing from benzodiazepines. GPs follow the guidelines for withdrawal but these give no warning of the serious consequences that can ensue. My doctors did not recognise the symptoms, did not know what to do. This is not unusual.

    I look at the history of benzodiazepine prescribing and realise that despite the 1988 prescribing guidelines stating a 2-4 week limit, these were largely ignored. Untold numbers of patients’ lives have been ruined. I wonder how this can happen. Presumably doctors’ clinical freedom is seen as more important than the protection of patients. The addictive properties of the drugs were well documented by the 1980s. Yet even today they are still being given to patients beyond the 2-4 week limit.

    I now see that one in four adults in Scotland is prescribed an antidepressant despite the addictive potential of these drugs. Almost everyone I talk to has been offered one and refused, given one and not taken, started taking but stopped and of course some have been taking them for decades. It is clearly not always the patients who want to take these drugs, rather it seems to be the GPs who feel the need to offer them. Yet there is increasing evidence that they do more harm than good. I am now much more aware of how little doctors really know about the medications they prescribe. Yet patients are under the illusion that their knowledge is greater than it really is.

    I look back over the years. When I had back pain I was prescribed painkillers which did nothing to solve the problem. An osteopath was able to fix it. For 10 years I suffered daily with the symptoms of IBS. Many pills were prescribed and diets were tried. In the end a chiropractor sorted the whole problem in 6 weeks. My spine was pressing on nerves leading to the gut. So much NHS time wasted, GP visits, tablets and so on and so forth. Surely there has to be a better way forward.

    GPs are undoubtedly very busy but they are creating so much work for themselves by making patients more sick than they need to be. Unfortunately many of the side effects of drugs are just treated with more drugs as you know. Patients do not want prescription drugs just for the sake of it, they want to feel well by accessing effective treatment. Those of us who can afford it are happy to pay for non-NHS treatments where they exist. it is not helpful that those trained in western medicine ridicule other health care practitioners whose methods are often more effective. I could have avoided 10 years of IBS if only I had known to consult a chiropractor. Better integration of mainstream and complementary therapies would be welcome.

Leave a comment

Your email address will not be published. Required fields are marked *