One of the chapters in the book I reviewed recently focussed on the current over prescription of statins. The authors’ scepticism is not new. Questions over statin therapy have been raised before and one Northern GP, Dr Malcolm Kendrick wrote a whole book on the subject some years ago.
Well Dr Kendrick, and other like minded doctors have probably been right all along, according to the Cochrane review, reported here.
Inevitably many doctors will ignore this review as the dogma involved in statin therapy is too deeply ingrained, and many of the more senior members of our profession have made their reputations in this area.
One such individual is Professor Nicholas Wald, advocate of the polypill, who feels that all males over 50 should be taking this combination drug. I disagree with him. There are now question marks over aspirin and statins for prophylaxis in healthy individuals. The other component of the polypill is hypotensive agents, and Prof Wald does not seem to give much thought to what happens when you give these drugs to normotensive people, or perhaps he thinks that there are no normotensives over 50.
I am normotensive, and once took a single bisoprolol tablet to see what would happen. Big mistake. Within an hour my heart rate was 40, and my BP 70 systolic. I felt like shit.
I have said before that the pharmaceutical companies have and do provide products of which they can be proud. But in their pursuit of ever bigger profit they are doing much to sully their own reputation. Perhaps we as doctors should be reviewing our relationship with them which is often far too cosy.
One of the biggest problems with Statins is they pretty much do not work! That is, even with the target cohort, because the MI risk is hardly reduced at all, as evidenced by this study;-
ReplyDeletehttp://www.annals.org/content/153/12/800.short
And in fact by many others. Wald and his partner in crime Prof. Law, are the architects of the 'polypill' as you know, and symbolise for me the worst aspects of Pharma and the 'cosy' relationship that many in healthcare have with them.
I cannot understand how GP's can perpetrate this appalling waste of public money, as 'preventative', when all of the evidence, proves the contrary. Women especially, will not prolong their life by even one day, by statin intake for twenty years! Yet statin's have now even become an OTC product, as well as being the most profitable and widely prescribed drug in the entire world.
NICE has a lot answer for in this together with the QOF regime that rewards, GP's for lowering BP, LDL etc to ever reducing levels. No wonder a lot of the patients, like you when you tried just one pill, feel like shit as a result. Worst aspect is, that all of these protocols have been singularly unsuccessful, because more people get fat, have diabetes and heart disease than ever before. Causal link?
As I was driving home from The Bunker - oops, the medical school - today I heard Sir Nicholas on Radio 4's PM programme, pooh-poohing the Cochrane review and saying (i) how exceptionally good statins were, and (ii) that the Pharma funding of almost all the published studies was completely irrelevant. On the first point (statins good) he seemed to be taking much the same line as in this comment on the original polypill paper.
ReplyDeleteI wonder when will this Statins prescribing nonsense be stopped? Statins are evil, they turn people into zombies and the formerly-well into sick-list persons.
ReplyDeleteHow can it be halted? All the 50 YOs are being given them like sweeties and they have influential jobs which they are likely to continue in for the next 20 years. I can spot a statin-junky at 500 paces, there is something about the vacuous face and general dazed-and-confused look which gives them away.