Call me a NICE anorak, but I have to tell you I’m incredibly nervous and excited about the final version of the lipid modification guidelines, which are due out any day now. No, I’m not fretting about whether the admittedly bonkers 10% CV risk threshold for treatment will still be there. My concern is rather different. And it involves section 1.2.4. of the draft guidance.
I’d be disappointed to have to remind you what this says. But I’ll repeat it here verbatim, just in case there really is anyone out there who missed it first time around: ‘Advise pregnant women to limit their oily fish to no more than 2 portions per week and to avoid marlin, shark and swordfish.’ (My italics).
Now, obviously, down Basildon way, they’re really into their big game fish. Particularly since the advent of the thin and crispy extra pepperoni deep sea special pizza, which comes impaled on a whole swordfish. Very tasty, but a bit of a bugger for the delivery guy. Nonetheless, Essex’s most expectant have taken my cutting edge, NICE-based advice to heart and have significantly cut back on their consumption of rollmop herrings, and now completely avoid any deep sea stuff.
Where I have had a problem, though, is with the marlin. The simple question, ‘Do you eat much marlin?’ has been met with the same look of blank incomprehension I receive when I try to explain to them why they don’t need antibiotics. They know – and I can vouch for this from a variety of crossed purpose (porpoise?) conversations I’ve had with confused pregnant ladies – of Merlin, Marillion, someone called Marilyn, someone else called Marlon, and melons. But, astonishingly, marlins are a completely mystery to them. I know. Basildon. Near Southend. On sea.
Not any longer. We have mounted a comprehensive patient education campaign involving posters, patient leaflets, messages on repeat prescribing slips, the practice website, texts, social media and so on, warning of the dangers of marlin. It would be a tragedy if NICE’s lipid guidance decides to omit this sentence from its final version.
Dr Tony Copperfield is a GP in Essex. You follow him on Twitter @DocCopperfield