NICE, MP's and Statins
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NICE has told an influential group of MPs that it does ‘not want millions more people taking statins’, despite lowering the risk threshold for prescription.
Chair Professor David Haslam and chief executive Andrew Dillon told the Commons health committee last week that GPs would not be compelled to prescribe the drug, pointing out that it ‘remains a decision for the patients’.
But the GPC has questioning the discrepancy between NICE’s updated guidance and public assurances from its chair.
The updated guidelines, released in July, say preventive treatment for cardiovascular disease in the form of statins should begin in patients with a 10% risk of developing the disease over 10 years. The risk threshold was previously 20% over 10 years.
Professor Haslam told the health committee: ‘I do want to stress as well that NiCE made it really clear that we are not saying we want millions more people taking statins.’
However, GPC clinical and prescribing subcommittee chair Andrew Green said there was ‘insufficient evidence of significant overall benefit to low-risk individuals’ to support cutting the prescription threshold.
He said: ‘What Professor Haslam says should happen between patients and their GPs is exactly right, and I suspect that as individual doctors our views are very similar.
‘The problem is, that is not what the guidance says in any of its key recommendations for implementation, which are quite definite about the offering of medication at the 10% risk level.”
Dr Green added: ‘The discrepancy between NICE’s document and the statements from its chair will do nothing to allay the concerns of GPs who have deep reservations about the wisdom of implementing such fundamental changes.’
When the new guidelines were published in July, the GPC expressed concern over the economic viability of prescribing statins at an earlier stage.
It also raised doubts over NICE’s claims that wider use of the drugs could prevent thousands of premature deaths, stating that drug treatment had not been shown to reduce mortality in low-risk patients significantly.
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diane98246 derek76
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derek76 diane98246
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Giving statins at the 10% threshold risks doing more harm than good, argues Dr Nick Chiappe I would not take statins myself this risk threshold, because the risk to benefit ratio is not as certain as the ‘experts’ say - and minimal for the individual. For example, for an approximately 3% chance of benefit to me, assuming statins were 30% effective at preventing stroke and heart attack, I would have to make myself a patient, rather than a healthy 50-year-old. I would have to take tablets every day, I would have to pay a minimum of £50 of my own money per year in prescription charges, have at least annual checks with my doctor and have a significant risk of side effects. As a GP of 22 years’ experience, I find it almost impossible to believe the very low rates quoted by Collins et al for side effects. At least 10% of my patients stop them for side effects, particularly muscle and joint pains, which clearly disappear on stopping the pills and restart on rechallenge. I would rather get/stay slim and exercise regularly, which would be likely to produce similar long-term benefits, with added fitness self-confidence and enjoyment of life. If I smoked or drunk too much, I would be better being helped to reduce these than take pills. Obviously the risk-benefit ratio improves as risks increase. I would consider treatment at 20% risk and do strongly recommend my patients consider it along with lifestyle changes. Treatment of risk rather than illness means for many patients we are breaking the ‘above all do no harm’ instructions of Osler, replacing it with a more modern aphorism ‘don’t worry about harming individuals if there is net benefit to society’.
brian03294 derek76
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A MUST read is:-
"How Statins Drugs Really Lower Cholestrol and Kill You One Cell at a Time" By James B Yoseph and Hannah Yoseph MD.
Apart from in those who have already had a heart attack (possibly due to an anti inflammatory side effect and NOT from reducing Cholestrol) Statins DO NOT reduce overall mortality one bit. Again FACT.
Cholestrol is highly associated with heart attacks
You do not reduce the number of road accidents by cutting the number of para medics (after all para medics are highly associated with road accidents).
You do not reduce the number of fires by cutting the number of fire fighters (after all fire fighters are highly associated with house fires).
Should we reduce the amount of Fibrin (scabs) produced by the body (after all Fibrin is highly associated with external bodily damage).
Correlation (association) does not imply causation