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To do or not to do



Well, 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.