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Coping with contradictory advice from the experts

Dr G O'Neill of Belfast was concerned about 'conflicting cholesterol advice' (Letter, June 30). He highlighted the effect on workload, contradictory advice from experts, the cost of drugs, and patient compliance.

Increasingly it seems GPs are worried about the implications of good chronic disease management, and there is a developing ambiguity between following evidence-based guidelines and managing individual patients, partly intuitively.

It has been said it is impossible to be too slim (and too rich) but also the thrust of current evidence is that lipids, blood pressure and plasma glucose cannot be too low either. It would appear, despite Dr O'Neill's anxieties, that risk factors should be addressed even more vigorously.

But GPs have to decide for themselves. There will always be a range of advice.

For example, there is recent evidence advocating thiazides as the initial treatment for hypertension.

Fair enough, but how many of us would actually chose it?

Dr Adrian Hutton,

Mildenhall

Suffolk

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