Posted by: Tony Copperfield
18 February 2014Well, you’ve read it, just like I have. You’ve rubbed your eyes in disbelief and read it again, just like I did. And now you’re punching the nearest wall, just like I am. Amazing what draft NICE guidance can do to us. Especially when the subject is primary prevention of cardiovascular disease and the plan is to lower the threshold 10 year risk for initiating statins from 20% to 10%. That is to say, roughly speaking, to qualify for statins, you simply have to exist.
There are only two possible responses to this.
Either:
1. You go with guideline flow and start scattergunning statins, watch your workload and prescribing costs hit the stratosphere, spend many happy hours discussing these drugs and their side effects with the punters, spend even more happy hours dealing with those side effects when they inevitably occur, manage the fallout when, having put everyone on treatment, there’s a ‘supply problem’ with atorvastatin, switch these patients to something else, switch them all back again when the supply problem is resolved and, finally, when NICE reverses its decision as per neuropathy guidance, paracetamol guidelines and a year’s worth of QOF criteria, stop the treatment on everyone, meaning that, effectively, despite having worked your gonads off for a year or two, you’ve done nothing.
Or:
2. Do nothing.
Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.
Readers' comments (4)
Anonymous18 Feb 2014 12:08pm
I agree. You need to correct the part of the sentence including " the plan is to lower the threshold 10 year risk for initiating statins from 10% to 20%."
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Anonymous salaried!19 Feb 2014 10:59am
Draft guidance does not equal completed guidance. If a patient comes to harm as a result of prescribing on a lower threshold, it would be hard to justify. I think it would be a good idea to prepare for this once the full NICE assessment process has been completed as it may be coming.
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Anonymous20 Feb 2014 1:17pm
A patient does not 'have' to take them... Write the Rx. Parient does not use Rx - tosses it ! NICE outsmarted with a Bosie googly ! Faces saved all round and NHS pennies still in the kitty...
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Sesha Rao25 Feb 2014 2:35am
This is as per the usual stupidity of NICE. One does not know where they get the info from or how they arrive at "guidelines. A fundamental principle should be - do not medicate unless necessary, and certanly, not on some dubious statistical bases.
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