Of all the animals of prey, man is the only sociable one.
Every one of us preys upon his neighbour, and yet we herd together.
The Beggar's Opera: John Gay

Thursday, 5 May 2011

Statins for all and a death sentence

Professor Sir Nicholas Wald said prescribing cholesterol-busting statins and blood pressure pills based on age alone would be much easier and quicker than the current system.

However, concerns about the side-effects of the drugs mean that the proposal would be controversial. [...]Addressing the concerns, Sir Nicholas said the benefits would easily outweigh the risks.

Once upon a time, there was a fit and healthy man in his early seventies. At his GP's request, he visited the surgery for a check-up, where he was poked and prodded in the customary manner before being told that his BMI and cholesterol levels were 'rising' - not 'high' or 'elevated'; just slightly above the previous reading.

The GP prescribed statins - this was at the beginning of the statins-for-all campaign as media doctors got on the bandwaggon - and the man, being a cooperative sort, obediently took them.

This man had a healthy lifestyle - didn't smoke or drink, ate well and took plenty of outdoor exercise - and was seldom ill, so when he started to feel unwell soon afterwards he went back to the doctor.

'Side-effects, that's all', said the doctor, and changed the brand of pills. Things were no better, so the man went back again and asked the GP to investigate. 'No need', said the GP, 'It's just side-effects of the statins' and the pills were changed once more.

The symptoms multiplied and still the doctor refused to carry out further tests - 'It's just a case of finding out the correct dose'. For over a year, things went from bad to worse until, in desperation, the man sought a second opinion.

The second opinion was unequivocal - aggressive cancer, now so far advanced that there was nothing left but palliative care; with supreme irony, detailed scans showed that the patient's cardio-vascular system was in excellent condition. The statins, now replaced by increasing doses of morphine, had been completely unnecessary.

This cannot be an isolated case, yet I have seen nothing in the concern expressed about side-effects mentioning that they may mask the symptoms of cancer and other serious conditions. I suppose that is one of the risks that is 'easily outweighed' by the benefits of statins for all.

That's the trouble with the way Sir Nicholas and his kind think of patients; as figures on a chart - one unnecessary death from cancer set against the prevention of several heart attacks constitutes an acceptable risk.

Mathematically that may be true, but I wonder if he - and his family - would still think so were he the one?

4 comments:

  1. Alas, it isn't, the number of people I know who have had real problems yet never been sent for routine testing by their Family (!!!) Doctors is growing larger by the month. One poor lady was almost two years on antibiotics for a "chest infection" and never looked at. The post mortem revealed severe lung cancer.

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  2. Good post. An option Sir Nicholas omits to mention is to have your DNA tested and be guided by that, rather than trust to a blanket statin prescription.

    A more insidious problem is best illustrated by a question. What if I take statins and avoid dying by a heart attack only to end up with dementia?

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  3. Demetrius, you're right (as ever); there are enough misdiagnoses and failures already without mass statin use muddying the water still further.
    If statins are universally prescribed then there will need to be far more costly investigation of symptoms, thereby undermining Sir Nicholas' main argument.

    AKH, thank you and welcome to the Tavern.
    A cardiologist of my acquaintance says (off the record) that there was never any need for the whole population to go on a low-fat diet just because certain individuals have a genetic susceptibility to cardio-vascular disease, yet government advisers adopted universal nutrition targets based on a 'lowest common denominator' rather than screen the population for risk factors.

    Good point about relative mortality; since the optimal result is to stay as well as possible for as long as possible, I'd also be asking whether the quality of life on long-term medication is really equal to that without.

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  4. "A cardiologist of my acquaintance says (off the record) that there was never any need for the whole population to go on a low-fat diet just because certain individuals have a genetic susceptibility to cardio-vascular disease, yet government advisers adopted universal nutrition targets based on a 'lowest common denominator' rather than screen the population for risk factors."

    Same with salt, which I notice is about to undergo one of those 'Oh, no it doesn't!' moments in medical advice...

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