Our NHS is in a complete statin

Dr Copperfield on prescribing statins to people with a lower risk of cardiovascular disease

I’d just waved my irony detector over NICE’s latest ‘Postcard from another planet’ aka latest draft guidelines for lipid modification and it buzzed so loudly that I knew I’d struck gold. Or rather, irony.

Because that same morning I’d also read about yet another NHS-in-crisis tragedy whereby a poor guy with a myocardial infarct had to wait indefinitely for an ambulance – despite correctly deeming himself at death’s door and his wife calling 999 numerous times.

This – like NICE statements that seem utterly oblivious to the current state of the NHS – is not an isolated occurrence, and was a real and preventable disaster. Preventable not in the sense that ‘if only he’d been on a statin’ this might not have happened, but in the sense that if only an ambulance had arrived and scooped him up to A&E, his chances would have been a lot better.

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And that’s my point. I admit I haven’t done the maths, but I don’t think I have to. To prevent one event by offering statins to hordes of people with QRisks below 10%, as we’re now advised, will cost deranged amounts of time and money: the NNTs must be astronomical. And I guarantee whoever has actually done the maths will have underestimated the enormous amount of time spent in primary care explaining, discussing, reassuring, dealing with side effects real or imagined, following up, arranging monitoring bloods, causing and allaying anxiety, doing annual medication reviews, chasing up defaulters, etc etc etc, because GP time is free, right?

All this expensive statinising to prevent something that probably wouldn’t have happened, or might still happen anyway. Whereas I’m guessing that an ambulance ride to A&E, plus some timely thrombolysis, probably costs a few quid, with an astronomically higher chance of individual benefit.

We should do both, I hear you say: prevent and treat. Sure, in an ideal world. But that’s not the one we’re living in, is it? And when you boil it down, everything’s about opportunity cost: unless there’s more funding, each time you prescribe another statin, the ambulance wait time increases.

Frankly, being asked to dole out what seems like a cost-ineffective luxury while the NHS can’t even provide the basics doesn’t just feel like irony. It’s borderline obscene.

Dr Tony Copperfield is a GP in Essex. Read more of his blogs here