Statins for all

Another salvo from Dr Spence to rattle a few cages.

I can't say that as a layman or as an allied professional that I have always agreed with Dr Spence, but his forthcoming retirement from writing for the BMJ is going to leave a gaping hole.

Dr Spence's legacy will be one of challenging the status quo and perceived wisdom of others; to inspire and to encourage debate and promote critical thinking.

A real mentor who will be sadly missed. I wish Dr Spence all the best for the future.

I would like to thank Dr Chand, the deputy chairman of the BMA, for drawing attention to the possible serious and debilitating side effects about which users of statins are not informed by the drug companies manufacturing them.

I was prescribed Simvastain 40g tablets in the 1990s following a transient ischemic attack when I was in my fifties. I then began to suffer breathing problems and a degree of muscle weakness and slowness which I attributed to the aging process. However I was able to carry on with normal life, albeit at a slower pace than before. However in recent years I have developed severe pain in the muscles of both legs and a feeling of extreme fatigue and weakness to the point that I can now only stand for a minute or so and need a wheelchair to move more than a few yards. Although I have suffered other health problems since 2006, none of these appear to be related to my current level of disability, and my GP is unable to provide me with an explanation of my physical condition.

My quality of life has been dramatically affected because of the constant pain in my legs and the impact upon my mobility of my muscle weakness and exhaustion. Every day is a struggle. When I read about Dr Chand's personal experience of statin use, it immediately struck a chord. I have ceased to take statins but my fear is that my long-term use of statins has resulted in permanent muscle damage.

I am therefore alarmed to hear the news that under NICE recommendations millions more adults could be routinely prescribed statins. The effect of statin use over a long period, particularly in the case of people with pre-existing health problems and in the older age group, should be the subject of independent research, not restricted to trials undertaken by the drug companies who will reap considerable profits from their increased use.

Yours sincerely

Campbell Matheson

THankyou Des.

It will be interesting to see what effect the debate that has started has on the final guidelines.

Yesterday I was at the RED WHALE GP-Update Course. This was one of the key areas they covered. They made the point that NICE does not neatly separate Guidelines (evidence based) from Recommendations (Consensus based in the absence of clear cut evidence). This would be a really useful distinction for Drs, journalists, and the public.

Sadly, although they emphasised that the recommendation was to OFFER statins when risk was > 10% (primary prevention) there was nothing said about how an informed discussion with the patient might be had and the DRAFT guidance was very much presented as what we can be expected to need to do from now on.

Although I'm glad statins are available, where given an informed choice patients often choose not to be on a statin for the rest of their lives.

My experience is that patients at around 20% Risk of a CV event (coronary
events, stroke and TIA) presented with Patient decision aids (PDAs) showing that a 25% reduction in relative risk over 10 years means that 100 people like them need to take the statin for 5 to benefit is that they most often choose not to take the statin and focus on life style change instead.

Des asserts that there is not really any new evidence. If others assert differently I'd be interested in whether there is an increase in smiley happy faces on PDAs to go along with this changed recommendation (offer treatment form 10% CV risk upwards).

When using PDAs with patients I’m not swapping from an expensive but no better statin to a cheaper and just as effective statin. And so I don't discuss cost because there is no need to at that point.

And when I say no better this is in terms of Patient orientated outcomes (POOs) – clinically significant, as opposed to Data orientated outcomes (DOOs) where any clinical significance is speculation.

If there is no real new evidence and patients (Using PDAs) tend to prefer not to be on Statins, and cost is not an issue that factors in the decision (at this point) then the use of PDAs needs to be right at the forefront of NICEs final guidance/recommendations, whatever they set the threshold at.

As individuals we are not able to make our views known to nice, they only accept the views of organisations. I will be approaching my CCG to see if they will be submitting a response, though I can't say that at this time of year it is going to be a priority for CCGs to meet the deadlines for NICE Consultations above their other responsibilities.