When Drugs Don’t Work, These Activities Might Help

In the United Kingdom a new medical trend is taking root, and it’s one that I can really get behind. Instead of prescribing pharmaceuticals, doctors are prescribing social activities.

In this type of therapy, called “social prescribing,” primary care physicians are encouraged to prescribe gardening, art classes, ballroom dancing and more for their patients.

It's gaining traction in the U.S., too, but is this just a fad, unsupported by evidence, or are there real benefits to be had?

Many illnesses are strongly influenced by social circumstances. Although doctors are well aware of this, their instinct is to reach for the prescription pad, even when the issue isn't really amenable to medical therapy.

For example, pharmaceuticals can't address social isolation and loneliness. Nor can they offer much help in getting to the root of the problem for those who are obese, have poor diets, or are struggling with diabetes, heart disease or depression.

So, the United Kingdom’s National Health Service (NHS) is promoting various initiatives to find other ways of dealing with these kinds of problems. The NHS has hired a team of people to educate doctors on existing services in their local community, ranging from opportunities for employment, self-help groups, social groups, gardening activities, and exercise classes, for instance. These NHS employees also educate patients.

Several pilot programs already exist, giving patients the chance to work in gardens, ride bicycles, try their hand at fishing or join group visits to museums. The hope is that activities like these will improve people's quality of life, enhance physical, mental and emotional well-being, promote physical activity, and lower levels of depression and anxiety.

Martin Roland, emeritus professor of health services research at the University of Cambridge, believes that social prescribing offers benefits not just to patients but to doctors, too, saying it "has the potential to change the nature of the consultation in ways that really have profound implications for medical practice and medical education."

It sounds laudable, but does it work?

Early Research is Underway

To date, the studies on social prescribing have been small. What’s more, the large number of factors and outcomes involved make evaluation complex, so it will take years to develop an evidence-based approach so doctors can know with confidence which interventions are valuable to what types of patients.

Meanwhile, some health experts are critical of introducing social prescribing before benefits have been proven.

Dr. Richard Rawlins, an orthopedic surgeon at Bedford Hospital, said, "Does NHS England want the NHS to be evidence based or is it content to countenance quackery?"

Dr. Edzard Ernst, from Exeter University, a well-known critic of alternative medicine, fears social prescribing "is in danger of becoming a tool for people who want to smuggle dubious alternative therapies into the NHS. What next? Crystal healing? Homeopathy?"

Meanwhile, Paul Wilson, a senior research fellow at the Alliance Manchester Business School, states bluntly: "The reality of the evidence base for social prescribing is a mess. Social prescribing will only be of value if its benefit can be demonstrated."

I suspect that these doctors, as usual with critics of alternative medicine, have not looked at the evidence that does exist – and there is a great deal. In our many years of writing on health, we’ve seen persuasive evidence that depression and lack of social interaction play a role in dementia and cancer, and that happier, more socially involved people also enjoy longer life expectancy.

And the evidence for the benefits of exercise is so overwhelming, I’m surprised the critics would slam a program that finds ways to get patients to be more physically active. In the UK, patients and doctors already report anecdotal evidence that social prescribing is helpful.

Depressed Patients Feel Better

Because of anxiety and depression issues, Alison was put in touch with an NHS worker who "listens, empathizes, encourages and informs, but most of all she saw some potential in me straight away."

Alison now regularly swims, volunteers in a charity shop, goes for walks and has clearly benefited from social prescribing.

Another example is a man who had been on nearly every antidepressant available with little benefit. Max Pemberton, his psychiatrist, suggested volunteering at a homeless shelter. "For the first time," the patient said, "I feel needed. I’m so busy, I forget I’m depressed."

Then there’s Catherine, who has lived with clinical depression for almost 20 years and who most days was "disappointed to wake up." Catherine was given a "nature prescription" by her doctor. A year later she says, "I’m incredibly attached to being alive and I have a vegetable patch to thank for that."

Gardening is as Good as Running

Gardening combines both physical and social benefits, promoting companionship, support, immersion in nature, as well as light exercise.

In one inner city doctor’s office, patients are given herbs, potted plants or trays of vegetables to tend to at home. They are also encouraged to work in the doctor’s communal garden.

The medical secretary for the practice, Augusta Ward, commented, "Having something to care for brings so many benefits to people.

"The plant is then a reason to come back to the (doctor’s office) and get involved in all the other activities in our garden and make new friends."

Dr. Lauriane Chalmin-Pui, lead author of a just-published study, said gardening is good for our mental health and can also have the same positive impact on well-being as cycling or running.

So, social prescribing appears to work, at least for some. Dr. Pemberton agrees, writing that it can be of great benefit for certain patients, but they need a good support system to go along with it.

"When done properly," he writes, "it can have wonderful results."