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Our NHS is in a complete statin

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.

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



Please note, only GPs are permitted to add comments to articles

Christopher Ives 16 January, 2023 8:17 pm

Has anybody asked nice to comment on any opportunity cost analysis?

Decorum Est 17 January, 2023 10:51 pm

Cool it TOP CAT!

GP time is free!

Peter Zacharias 18 January, 2023 9:24 pm

ZACGDANSK. Dr.James Lefanu’s 2018 book “Too many Pills” forensically analyses the statistics and the politics in the long campaign to appease the pharmaceutical industry ; without troubling to include informed consent before “treating” mild hypertension and lipidaemia. NICE would struggle to rebut his accusations. The result is polypharmacy and iatrogenic illness which is rewarded in General Practice. How few lives are saved by this scam ?

Paul Burgess 20 January, 2023 10:31 am

What monitoring bloods? My GP has never asked me to have monitoring bloods for my statin. For which I’m grateful.

paul cundy 20 January, 2023 10:36 am

Dear All,
Spot on, do the maths.
100 people take a statin to prevent 2 events a year.
those 100 people then have a 9% increased risk of developing diabetes, for 45+ year olds thats 17%, for 65+ its 25%.
So from the 100 people 2 or 3 will develop diabetes as a result of taking the statin.
Once diabetic their risk of IHD goes up 300%.
Paul Cundy

Y oh Y 22 January, 2023 10:35 am

Brilliant analysis. Chimes in beautifully with this
Guidelines should consider clinicians’ time needed to treat
BMJ 2023; 380 doi: (Published 03 January 2023)

“This deserves to become one of the most influential articles we’ve ever published: why and how clinical guidelines should consider “clinicians’ time needed to treat” Kamran Abbasi

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