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The great statins folly

As statins take on a sort of messianic role, a perplexed Phil says they're a very naughty boy

As statins take on a sort of messianic role, a perplexed Phil says they're a very naughty boy

I think I'm quite a good GP. It's a complex job and it's difficult to quantify these things, but the small amount of evidence we do have (patient feedback, number of complaints, referral rate, Christmas card count, number of fights involved in at work) would tend to bear this out.

One of the characteristics of a good GP is knowing what you're not good at, and I'm not a good biochemist. Truth be told, almost no GP is a good biochemist, and that's as it should be. Biochemistry is arcane, confusing, boring and constantly changing. No expert in this field is likely to have the same insight into the human condition that good GPs are blessed with. Biochemists often have poor personal hygiene too, which again in a GP is a distinct disadvantage.

Which brings us to the small matter of cholesterol. Almost none of us knows what it is, where it comes from or what, if anything, it does. And yet we as a profession are responsible for distributing awesome and increasing amounts of cholesterol-lowering drugs throughout our society, for fostering growing anxiety and obsession about cholesterol levels among our patients, and for wasting vast numbers of appointments, investigations, and literally billions of pounds of public money on what I am coming to believe is nothing but a monumental folly.

I've always had an uneasy feeling about cholesterol. It's a long time since I left medical school and science has moved on, but the version we were taught, about this claggy toxic fat forming into clumps on arterial walls and forming plaques and then clots, seemed ludicrously simplistic for such a multifactorial and complex disease. But a more modern interpretation, such as it is, seems equally unlikely.

Dividing a protein, however complex, into 'good' and 'bad' has my hackles rising. Chemicals have no morality. Statins worry me even more. It has been suggested by apparently sensible doctors in positions of influence that it might be a good idea to introduce statins to the water supply to make all our lives longer. Statins are apparently a panacea. I have my doubts. A class of drugs with so many potential and actual side-effects, and which is so toxic and occasionally fatal to fetuses, is unlikely to produce only positive effects in adults. And the proposition that 'statins = lower cholesterol = less heart disease = fewer deaths' is taking an awful lot on faith, in my opinion. No scrap of evidence

However, as I have said, my opinion is not worth much. Let me direct your attention to The Great Cholesterol Con, a book by Dr Malcolm Kendrick, a GP in Cheshire. Dr Kendrick is that rare creature, a GP with the time, inclination and enthusiasm to examine the original evidence, and he has drawn some remarkable and persuasive conclusions. It's not possible to condense the findings of his book into one short column, so I'll choose just one fact, well-supported by all the major studies, and I feel that this next sentence should be printed in italics, it is so revolutionary. There is not one scrap of evidence that prescribing statins to women will increase their life expectancy by as much as a single day. The evidence is shaky enough in men, but in women it is unequivocal and applies to both primary and secondary prevention.

We are wasting our time prescribing statins to women. We are giving them only side-effects and the impression that they are ill. Think about this: at the very least half of our patients who are taking statins are having their time wasted and may actually be harmed by what we are doing. It is a shocking concept. You might think that it is unlikely that so many educated and apparently sensible doctors could be so profoundly wrong about something as fundamental to our work as this. But I live in a world where the likes of communism and astrology have thrived despite the sobering effects of research and experience.

Statins are taking on a sort of messianic role, and even our very income depends upon prescribing them. Please forgive the paraphrase: statins are not the messiah; they're a very naughty boy.

Dr Phil Peverley is a GP in Sunderland and PPA and MJA Columnist of the Year

To read Dr Malcolm Kendrick's Pulse columns on statins and other topics, search for 'Kendrick'

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