Intended for healthcare professionals

Rapid response to:

Education And Debate

Risk factor thresholds: their existence under scrutiny

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1570

Rapid Response:

Lives at risk

Shortly after the publication of Law & Wald's article on risk
factor thresholds (or lack of), the national media gave massive publicity
to the recent Lancet study suggesting that statins should be used much
more widely, because of their benefits even at relatively low lipid
levels. One national broadsheet quoted an eminent cardiologist as
advising GPs to ignore NHS guidelines and begin widescale prescribing

I sometimes - well, quite often - wonder if consultants have any idea
of the daily lives of their GP colleagues, and this is a case in point.
Not only are we faced with constant downward pressure on our prescribing
costs, which would be blown through the roof by the measures proposed.
What depresses me more is the fact that an ever increasing proportion of
our time is taken up with trying to manage legions of perfectly well
individuals who - having submitted to the friendly-sounding offer of a
'well-person check' - find themselves the subject of risk factor analysis.
Next they are asked to adopt the role of compliant patient while we carry
out more blood tests and ECGs, and soon they are taking two, three or four
drugs, entered on a 'disease register', and called back for examinations
and investigations until released by death.

What is truly sickening in all this is that while we in the affluent
world spend exorbitant sums on drugs to postpone by a year or two deaths
caused by normal ageing processes, the vast majority of the world's
population hasn't even enough to eat.

Let's get things in perspective: how about being prepared to take a
few risks in our stride for once?

Dougal Jeffries

General Practitioner

Isles of Scilly

Competing interests: none, apart from an already overspent drug

Competing interests: No competing interests

11 July 2002
Dougal J Jeffries
Isles of Scilly TR21 0HE
St Mary's Health Centre