The controversy rolls on.What is not controversial is that CHD rates have fallen dramatically since 1980,but our risk calculators have not been revised,also reading the original papers roughly 2/3 of the original selection were excluded from the trials known as the off label run in so the high side effect levels were known by the investigators .Hippesly -cox the unwanted effects of statins may help BMJ
Having spent much of the week looking at MRI reports (none ordered by me)it is clear that a lot of disability is due to disc lesions ,Yes most get better in practice but those that don't need a rational plan of action ,a clear lesion can be refered a normal spine told it will get better ,ok I am seeing the failures but thee are a lot of them ,perhaps NICE should do my job.
Start by realising the 10% figure is for a cardiovascular event not death possibly an ecg change or anginal attack and that some will experience more than one so less than 10% will actually experience a problem and the prevention rate in a high risk population is 1 in a 100 in woscops 1 in 800 for males over 10 years 1 in 3200 for females if statins work at all in females and there is good evidence from the quoted trials that they do not these trials also have high numbers of smokers ,WOSCoPS 46 %
all that has been demonstrated is how to load statistics .In the 50-60 age group in the whi trial HRT reduced cv events by 45% but the control group were on statins and aspirin !!!!
HMA CO REDUCTASE inhibitor stops the Krebs cycle pedaling ,raises blood glucose ,inhibits t cell function, reduces muscle contractile force ,slows neuronal transmission.Statins are produced by yeasts to kill living tissue so they can absorb the juice ,muscle weakness ,brain ,fog ,depression and failure to respond to infection are statin effects whether you are aware of them or not!
All statin studies eliminated known reactors to statins by off label run in ,as in Woscops and heart protection study 66% were eliminated it would appear that two thirds of the population react to statins adversely ,Hippesly cox in her paper in the BMJ gives 50% incidence of depression.
The last 5 ano rectal cancers i have diagnosed have been by the old fashioned finger all lower respiratory infections have been by percussion and stethoscope .Can't be done virtually sorry
Having a complaint that has arisen because the patient was mistakenly advised by an SHO in A&E that she should be refered after 2 weeks which she took to mean immediately perhaps some other areas need complaining about .Underfunding pehaps ?exccessive useless data entry?
Changing medical practice is like steering an oil tanker the risks of aspirin have been known for years yet i spend time battling with vascular colleagues who insist on its use ,even when the patient has reacted !!!
NICE in an earlier review of statins identified the problem of 'off label run in' this is done in trials to ensure compliance usually about5 to 10% drop out .In woscops the figure was 66% 4s 45% heart protection 60% with a further 18% of the trial group failing to comply but not the placebo group .In a recent study at kings by a colleague compliance with statins was to the order of 25% and in Hippesly cox's paper unwanted effects of statins 50% of statin users suffered from depression .these are wildley excessive figures and if you bother to check the ck about 10% will have elevation .No serious side effects! This is cloud cuckoo land
Two comments ,the metanalysis of trials suggests a saving in lives greater than the current death rate from CVD clearly impossible .The use of Qrisk in London 20% of the uk population wildly overestimates CVD risk as its weighting factors ,Rented accomodation and car ownership are first very high and second very low .This is due to political pressure ,the registrar generals social class classification and weigting by a factor of 2 for south asian ethnicity are better indicies .In any case the CVD death rate south of the wash is near japanese rates .The factors that reduce CVD are 1 stopping Smoking 2 exercise 3 avoidance of sugary foods fat is in fact negativley correlated with cvd 4 reducing weight ,Statins do not work on women or the over 70's in any of the papers i have read
always watch cardiologists fiddling with statistics 10 % 10 year risk of a cardiovascular event means the average sufferer has 4 events so in fact only 2.5 %of the group are actually afftected also statin arm of ASCOT trial more deaths in statin arm than control from cvd .Gp's are not supposed to check data !
When will someone come up with evidence that stains reduce heart disease in women so far in 20 years and numerous papers no exidence .Why Q risk it gives utterly bizzare levels of risk in southern England because it relies on car ownership and living in rented accomodation .ie a measure driven by politics not evidence
and will the vaccine work ? immunisation response is poor over 65 and shingles usually is a marker of poOr immune response .Flu vaccine only produces an immune response in 6.5% of over 65 recipients so I suspect this will be one of the great ministerial failures .more work but no benefit ,bit like filling in the GPPAQ
Hippesley -cox paper The unwanted effects of statins bmj 2008 50% of patients on statins became depressed ,more had cataracts ,Quarteley journal of medicine all patients on statins have loss of muscle mass .All statin trials roughly 66% eliminated by off label run in ie using the drug and removing the reactors from the trial .Whi trial no benefit of statin and aspirin in women but 50% reduction in 50=60 age group on hrt people just don't read original papers with sufficient cynicism
Maybe we could but qof and commissioning will have to go!
Given that checking through my patient evaluation sheets half my patients did not have english as a first language ,perhaps a bias to consulting with middle class english patients is not appropriate .Very few patients I see are English ,.Is the college looking at an out of date consultation model ?Standard joke these days is that I am the only englisnman in the practice!
The "just a cough doctor" 5 cases of TB one of lung cancer .
"can i have something for constipation" he has responded well to chemo .
Persistent rash ,Oh this one just happened to be Leprosy and yes the mant people you could ressure and send home educated
Being very pedantic Sturmbahnfurer is an SS rank and has not been used since1945 a Bundeswehr major is just that a sergeant major is a speiss ,My suggested cure ie a few days training with a fallschirm batallion
exercise hard ,good company ,good beer and a diet of rye bread bratwurst and cheese .
Aspartame was not licensed in the uk in the 1960's as a result of testing at BiBRa where i worked .The UK ban was overturned by Brussels despite evidence of harm in the 1980's commercial lobbying overrode scientific evidence but as a tech handling the trial I definitely would not willingly take it .it is widely used in diet soft drinks because it does not have the saccharin aftertaste