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CAMHS won't see you now

Statin the bleeding obvious

Copperfield 

I have a question, and I’d like someone clever out there to answer it.

To explain: one of my HCAs came to see me the other day. Big panic. She was doing something wrong, she said, with the NHS Health Checks.

No matter that the individual’s health she was checking seemed faultless, blameless and therefore potentially endless, the QRISK was coming in at >10%. And this was happening repeatedly. Was she, she speculated, forgetting to subtract the patient’s inside-leg measurement, or something?

The back story is that we have, for a long time, resisted providing NHS Health Checks on the basis of all the well-aired arguments, which could be summarised by saying that these checks are a politically-driven, non-evidence based heap of dung. However, when an activity, even a bonkers one, becomes the norm, there comes a time when a principled stand starts to looks like laziness or neglect. Plus we needed to earn some more cash.

So here we are, with a confused HCA and frightened patients. Of course, there’s actually nothing wrong with the way the HCA is performing the health checks. She’s simply forgetting that the single most important parameter is the one we’re all powerless to influence: age.

Why invite men over 59 or women over 65? Just send them a pack of Atorva on their birthday

As I have mentioned before, no matter how perfect your parameters, once you hit 59 (male) or 65 (female), your risk score is inevitable above 10%. Which means that, according to NICE, we should be offering statins - and NICE’s mealy-mouthed qualifier about trying lifestyle interventions first counts for nothing in this group, unless those interventions includes a device to reverse ageing that they’ve forgotten to mention.

So here’s the question. As the end game of any NHS Health Check is the calculation of the QRISK score and therefore a take-home prize of statin eligibility, what is the point of inviting any male over 59 or female over 65, given that the outcome is a given? Why not just send them a pack of atorva on the appropriate birthday, with a repeat prescription slip for those who like the taste?

While I’m waiting for someone to enlighten me, I can console myself with the fact that a green paper was produced last month on ‘Prevention in the 2020s’. Everything about it is ‘Bold’, not least the adjective ‘Bold’, which has clearly replaced ‘Robust’ as the politician’s go-to word for when they’re trying to convey that they mean business. It appears countless times in the document, almost always followed by the word ‘action’.

And the ‘Bold action’ with NHS Health Checks will apparently make them more ‘intelligent’. Which sounds good until you realise that means maximising uptake (so much for informed consent), increasing the range of checks offered (so much for evidence) and considering a ‘retirement MOT’ (so much for feeling carefree when I hang up my stethoscope).

I sent in my above questions to the consultation. And I pointed out that my personal future vision for NHS screening and prevention would be one that delinks scientific medicine from political propaganda. Now, that would be bold.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield

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Readers' comments (14)

  • The only surprise is that anyone thinks they are earning money from these. Suspect most people who do have not adequately accounted for the follow ups and admin time involved.

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  • one of my old profs told me if you test for it then you have to action the result, if you are not going to action the result why are you doing the test?. never going to be tested cause i aint going on statins. no FH. no point. Having recently had a conversation with a 98 year old with a long standing cholesterol of 8.9 or more who was asking if they should start on statins its all getting rather silly.

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  • you are right stelvio, however when i declined to take this on PCT said they'd commission this to some s**t provider that would do the job poorly and I would still end up with all the work.

    True to their word, every patient seen came with a bit of paper directing me to do a diabetes test (whatever that is) based on BMI25 and renal function test (based on incorrect BP) as the provider did not do any counselling, management or follow up, or to summarise, a s**t job.

    I can see therefore one could be persuaded to do this in-house no matter how nonsensical waste of resources.

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  • Missed this post. Enlightenment herewith. If a protocol comes up with a stupid answer something is wrong with its basis. Mankind has existed without statins for millennia. Most of the risk studies cannot disentangle other factors such as smoking and obesity but the bottom lines are (1) the quoted risk reduction from statins is relative; the absolute reduction is not statistically significant and (2) blood cholesterol is not a consequence of too much dietary fat because it's synthesised from carbohydrate in the liver and (3) cholesterol in plaques does not seep through from the bloodstream but is deposited as part of an incomplete repair process following inflammation, which is quite independent of the level of blood lipid. It follows therefore that the whole basis of the algorithm is based on a false premise, and I am only sad that the influencers, many of whom are paid handsomely by the statin industry, See unable to understand basic science. Self-justification papers continue to mislead. For the latest Lancet example it's worth reading the elegant dissection by Zoe Harcombe in her blog.

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