Wednesday, 7 July 2010
It's Those Statins Again !
A new meta analysis, published in the Archives of Internal Medicine today and given some prominence in both Pulse and SearchMedica, highlights the fact that there is no evidence that statin therapy has any effect on all cause mortality, even in high risk categories of patients, without a history of CVD. Makes you feel like saying 'told you so'. Some even advocate we give them to children! I kid you not !
With more than 65,000 participants and spanning some 39 years, I find this pretty conclusive evidence, to stop spending our money on pointless, expensive, and potentially harmful treatment protocols, for relatively healthy people, who fall the wrong side of a line drawn, by the very architects of the drug used to treat those who do. And of course, the line moves, in concert, with the never ending greed of 'Big Pharma'.
The jury is still out, on the use of statin's in patients presenting with existing CHD/CVD, although, even that has pretty flimsy evidence in it's favour, to say the least. But, it is without doubt a useless protocol, for those who do not have heart disease already, but are classed as 'at risk'. Probably by gist of one of the several 'risk engines' available in health care that predict that likelihood, but again, are notoriously poor at doing so, with any degree of accuracy ( The Framingham Index being one). The elderly, hypertensives, and diabetics are generally those targeted, to their detriment and that of their future health. I personally have talked to women, put on statin's, because their overall cholesterol level was above 4.0 mmol/L ! Is there a conspiracy in the GP cohort to enrich 'Big Pharma' ? Because that sort of prescribing is profligate, and is bordering on dangerous !
But, so long as NICE keep churning out the guidelines, that allow it, and provide financial incentives for those that prescribe, then Doctors will keep writing the the scrips, doing the lipids profiles, and telling us all we need to get our cholesterol down to an insanely dangerous low level. Of course it isn't even cholesterol it's simply it's transport molecule level, i.e. the total lipoprotein level in the blood, about which they generally know bugger all !
In these austere times, when money for health care is under pressure, it seems stupid to continue this pointless exercise, for the enrichment of the pharmaceutical giants, and give incentive awards to Doctors to medicate patients, that do not need to be treated, except in the la, la land of Quality Outcome Frameworks. These are set, in the misguided belief, that interventions of this type, will make us all more healthy and save the NHS money in the future. In fact this group, despite the (often) cocktail of drugs they are taking, present to hard pressed A&E, just as frequently with CHD/CVD, as those who do not. Of course it isn't just the Doctors time, and the drugs cost, it's the test protocols that also become necessary, at regular cycles to ensure that these so called 'benign' drugs are not destroying liver, kidneys or other organs of the recipient, or worse, precipitating the very thing they are alleged to prevent; heart failure. It seems ironic that the drug used to prevent Coronary Heart Disease, can of, and in itself, bring about muscle wastage to the extent that heart failure ensues.
In diabetics, there are 17 Quality Outcome Frameworks to structure their lifestyle, and lipid modification even if their (so called) cholesterol is near normal will likely be invoked, condemning them to a lifetime of statin therapy. This will be in addition to other protocols, involving blood pressure lowering medication, again even if their BP is normal and various interventions to keep their blood sugar within guideline levels. DM23 for instance, which has now been proven as being too stringent and putting Type 2's at risk, being just one, is being reviewed in the light of evidence that it is dangerous. All because, I believe mainstream medicine will not review it's strategy of low fat diets instead of low carbohydrate diets for diabetics. Doh !
The cost of the tests, drugs and Doctor time for the 5 million people the NHS suggest needs these drugs (statin's that is). Well, we do not quite know, but the drugs alone come to a £billion, the tests probably another at least, and that does not include Doctor time, the bonus paid for achieving the QOF, or the huge cost to the patients who have suffered from the many adverse outcomes, even death, from the use of statin's. I think that £3 billion would be a fairly accurate estimate. You could re-open a few wards with that sort of money, or even train a few Doctors (perhaps even properly, so they know what they are doing).
'Primum non nocere', is perhaps something those who advocate these drugs, should remember.
Next up, diabetics (type 2 that is).