Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

‘A mature conversation is needed over statins’

Many factors have to be taken into account during a consultation over whether to start statins, explains Dr Ivan Benett, clinical director of Central Manchester CCG.

The changes in statin prescribing, albeit very gradual, are good and not a surprise. The nature of uptake necessarily means that there will be early adopters, who take things up before the majority.

Like all decisions in medicine, prescribing statins for primary prevention is based on balancing the opportunity for benefit, the risk of harm, the patient’s wishes and the relative priority of the system – in terms of resources, time and other considerations like opportunity costs.

The opportunity for benefit and risk of harm are understood and perceived differently by different people, however strong the ‘objective’ evidence base. A 10% risk of a cardiovascular event means different things to different people. In terms of benefit or reduced risk of harm there is great confusion amongst professionals, let alone the lay public, between absolute and relative risk. Even when professionals understand the difference, translating that into language people understand can be difficult.

In addition, the pharmaceutical industry has a vested interest in over-promoting minor benefits while cynics have seized on the down sides to intervention.

It’s therefore difficult for a ‘jobbing GP’ to translate the evidence to individuals, and you can see why they would and should be cautious. Indeed this is made even more so by the fact that the doctor carries the clinical responsibility for any decision made about interventions, especially if the intervention causes harm. Thus there is always a bias towards the status quo and non-intervention. We are driven by the injunction to ‘first cause no harm’ which paralyses us into inaction – even when the benefits are clear.

It is our responsibility, as system leaders, to put the case for change and to be optimistic, but we need also to recognise that behaviour change is slow – people need to be quite sure that they as an individual will benefit, and not be harmed, by an intervention.

A mature conversation with a knowledgeable and empathetic GP will balance the potential benefits of taking a statin against the remote risk of harm, while allowing for the patient’s autonomy to decide as well as the costs and opportunity costs. This means that not everyone who might benefit will take up the intervention. And that is perfectly acceptable – provided the patient has had the chance to make an informed decision.

Dr Ivan Benett is a GPSI in cardiology, member of the National Cardiovascular Intelligence Network and clinical director of Central Manchester CCG. 

Rate this article  (2.6 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (5)

  • "A mature conversation with a knowledgeable and empathetic GP will balance the potential benefits of taking a statin against the remote risk of harm, while allowing for the patient’s autonomy to decide as well as the costs and opportunity costs. "

    I don't know about you Ivan but I personally do not have the time ,nor the patience, to explain all that to those who mostly don't give a toss about what we tell them. Their friend knew a friend who had muscle and joint aches and that is nuf said for them. Even if we do manage, after wasting non-existent energy, to "sell" the 10% risk statin thing, how do we justify the false reassurance that we provide? They will continue drinking alcohol and eating junk food while being even bigger couch potatoes thinking they are now safe.
    NICE guidelines are produced by "posh" sods with heads in the clouds looking for academic glory without any knowledge of real people.

    Unsuitable or offensive? Report this comment

  • 10% [10 year] risk of a CV event is a 90% chance that nothing will happen to you anyway [in terms of that CV event]. If we put it like that - and it's factually correct to do so - would anybody take the statin?

    Unsuitable or offensive? Report this comment

  • I dislike the expression "early adopters". The history of this expression is interesting and worth considering.

    I personally find this short piece telss me more about the writer's views than the evidence or ethics behind prescribing.

    I say this as a non-GP who has no fixed view.

    Unsuitable or offensive? Report this comment

  • Ivan Benett

    Anonymous | Sessional/Locum GP29 Oct 2015 1:26pm - how sad.

    Peter J Gordon | Consultant30 Oct 2015 10:15am - not sure what you're saying - yes of course, these are my views. What about yours? What other expression would you use for people who adopt change early on? Why don't you like the expression?

    Unsuitable or offensive? Report this comment

  • @Ivan - How about Guinea pigs? Fools who rush in?

    I think the issue is that there is an implied superiority, and a sense that they are somehow correct due to being first. Unfotunately this chronological determinism is only proved or disproved with the benefit of hindsight. I suspect this is why for the majority they would rather wait and see whether this proves to be first to folly or pioneering.

    Unsuitable or offensive? Report this comment

Have your say