Doesn’t stop it from being profitable if you sell them by the million.

Once a drug is out of patent anyone can make it, so the profit margin is tiny (a few %).

From that BBC link at the top: “Currently, doctors are meant to offer statin tablets to the estimated seven million people who have a 20% chance of developing cardiovascular disease over 10 years, based on risk factors such as their age, sex, whether they smoke and what they weigh.”

You can’t do too much about your age and sex, but the other two are highly influencable. (I thought we were having a chat by the way, not trying to win.)

Kimbers and Legolam make valid points and are probably massively frustrated by the great unwashed giving them a hard time. But from the point of an individual, being told that studies and stats hold the answer is equally frustrating – I am not a number.

Stats and studies can be used to prove any point of view – for example, the fact that saturated fat causes heart disease was the personal belief of one Ancell Keys. A study that he ran to prove this point of view failed to show a correlation between fat and heart disease (this was pre trans fat days), so he tidied up the data to make it fit with his personal point of view. Keys work has now been utterly discredited. But his work was scientific and peer reviewed and published in respectable journals, so why should we believe anything from supposedly credible journals?

Equally, the link between cholesterol and heart disease is being questioned – that’s not to say that there isn’t a link, just that a more nuanced understanding is emerging. For example, not all LDL is created equal and there are vLDL particles that do the damage. Yet, just because you have a high LDL count it does not necessarily follow that you high vLDL. See, it’s nuance.

When you see a GP or cardiologist in the UK they don’t want to talk about vLDL because it challenges the accepted orthodoxy that they have loads of studies to support. Those studies are valid, but they don’t tell the whole story and shouldn’t be relied upon blindly. Remember Ancell Keys?

And if you were to ask a GP or cardiologist about inflammation markers, then watch the colour drain from their faces. Inflammation, not cholesterol (although it clearly plays a role), is likely to emerge from the beloved literature as the biggest cause of heart disease. So, cholesterol is likely a symptom, not a cause.

What causes inflammation? An increasing number of studies – for what they are worth – are finding a direct link to low fat diets and grains. And what does the medical establishment want you to eat? A low fat diet with lots of grains…

The NHS doesn’t like informed patients. 😐

Also, what constitutes “high”? I’m not looking for an answer from the forum, just pointing out that there may not be a single answer for everyone, and blindly taking a drug with known side effects may not be a simple decision.

The real answer is..there is no answer…!

In primary prevention (i.e. hoping to prevent heart attacks), we (GPs) review all teh factors you think that we don’t (age, sex, lifestyle, other health issues, BP etc etc etc) and then come up witha ‘risk figure’.
I.e healthy ol’ me may have a cholesterol of 5.6 but have low risk. Overweight, diabetic Bob may have a cholesterol of 5.2, and benefit from statins.

Google q-risk..

We don’t just sit here mindlessly doing what ‘big pharma’ tell us to do… On wednesday mornings and Friday lunchtime, we do actually sometimes think for ourselves and involve patients in the discussion too…

DrP

The NHS doesn’t like informed patients missinformed people who spend hours trawling though google looking for any crackpot theory that challenges the status quo, assuming all doctors are idiots out to kill them and therefore expect the GP to perscribe that crackpot theory.

Fixed that for you.

I’m sure the NHS do like treating people who are actually well informed. I’d bet other doctors are quite easy to treat.

As a medic (not cardiology) my job is to offer an opinion to patients based on expert knowledge and experience.

The patient can choose to listen or ignore that advice as they see fit!

Google q-risk..
Fascinating. I’m glad I’m the real me, not one of the many fantasy me’s I tried in the calculator 🙂

I know a family- all 4 work in hospitals, 2 professionals. All but one is quite overweight. When they walk the dog they DRIVE it to the local park and back. For some people their habits/lifestyle/food is engrained into them from a very early age- its all they’ve known. Hence why now I still eat Broccoli almost daily without complaint and have a naughty taste for liver. Same with bad-eaters, its hardwired into them. Hence GP’s will tiring write out prescriptions for the ‘lost’ (lost can be any age) I imagine.

For those people drugs are firefighting-tools. They’ll never change.

It’s pretty simple really, if you don’t want to take statins, you don’t have to take them. No-one’s being forced to take them, its not like they’re putting it in the water, is it?

No doubt there’ll be loads of people who will take whatever their GP tells them to whether they’re right or wrong and they won’t research it to make up their own mind. Good luck to them.

I’m sure statins have their use, but they crippled my Grandfather for the last year or so of his life.
None of the doctors I spoke to could give a convincing answer as to why they were prescribing them.
He made it to 90 though, and I remember his last words fondly;

“Sbob, I must have been a very naughty boy in life as good people would never live this long.”

😆

Sorry, just using this thread to talk about me Grandad, I’ve never admired and respected anyone like I do him.

MrsT had to stop taking them due to side effects eventually preventing her going to work. She is not the healthiest of persons due to other health issue and takes a daily concoction of drugs which the statins probably clashed with. Her GP finally agreed with her that she may be the 1 in x thousands of people who may(do)suffer from severe side effects once she stopped taking them and problems disappeared.
MrsT also found out that (some?) GPs were/are being “incentivised” to prescribe statins to the “at risk” group. 🙄

MrsT also found out that (some?) GPs were/are being “incentivised” to prescribe statins to the “at risk” group.

Not having dead patients is a compelling incentive….

MrsT also found out that (some?) GPs were/are being “incentivised” to prescribe statins to the “at risk” group.

I’m sure the ABPI would be pleased to hear the evidence.

Not directly related to statins, but kind of on topic. Interesting reading…

The plot to make Big Food pay

11 graphs that show what is wrong with modern diet

What the BHF wants you to eat

If only the ‘going for a walk and eat some salad occasionally’ industry had as much political influence as Big Pharma.

Big Pharma, the research-based companies, get naffall from statins, see above. Of course there are likely to be side-effects if millions of people take them, but those which are reported are noted. Every company making & selling drugs has to monitor side-effects of their drugs on a weekly basis, so even duff batches will probably be picked up.

NICE is widely respected throughout the world as having effective ways of monitoring cost-effectiveness of treatments, and advises many other countries.

I’m not questioning the integrity of NICE or the GPs likely to be most affected by this change. But in all the coverage it might be nice to find space to promote the simple changes in lifestyles everyone could make. You know, like going for a bike ride.

You know, I see plenty of articles about promoting healthy lifestyles. Don’t you?
This was about something else. Related, relevant, but something else.

You wouldn’t expect an article on cycling for health to suggest people take statins / ACE inhibitors, would you?

Furthermore, in secondary prevention (i.e you’ve GOT heart disease, but don’t want it to get worse) there’s a benefit of statins BEYOND just lowering cholesterol – think of it as probably being ‘protective’ of the blood vessel.

I’m not overly ‘pro’ or overly ‘anti’ statins – they have a role when needed/advised.

DrP

big user i have high cholestrol and BP, i ve had a valve high user.. i have replacement two heart attacks and a tia..
statins are uncomfortable especially in the first 8 weeks. i believe they make my life longer so i stick with em..

So, cholesterol is likely a symptom, not a cause.

What causes inflammation? An increasing number of studies – for what they are worth – are finding a direct link to low fat diets and grains. And what does the medical establishment want you to eat? A low fat diet with lots of grains…

Furthermore, in secondary prevention (i.e you’ve GOT heart disease, but don’t want it to get worse) there’s a benefit of statins BEYOND just lowering cholesterol – think of it as probably being ‘protective’ of the blood vessel.

This to me is the crux of the issue.

Whilst I am not a fan of statins, there is a lot of evdience to show that statins clearly work in lowering CVD, but not through lowering cholesterol.

However, they also do not lower overall mortality.

So whilst you wont die from a heart attack you are just as likely (maybe more likely) to die from another disease, e.g. cancer within the same timeframe if you dramatically lower your cholesterol.

What is driving CVD is damage to your blood vessels, be it through poor diet, lack of exercise, stress etc. Cholesterol is simply your bodies way of trying to protect those vessels. So what you need to do is target the cause not the symptoms.

Unfortunately as we know most people would rather take a pill then adopt a healthy lifestyle.

I’d bet other doctors are quite easy to treat.

Interested in a Dr’s opinion on this, easier, harder or generally no different?

Stokes cost the economy something like around £7bn a year Hear Disease is nearer £30bn to the NHS alone, figures might be slightly off or outdated as I can’t recall fully.

So spending £500m a year to reduce the almost £40bn a cost a year makes sense to me let alone the lives saved. There’s possible side effects to any drug it’s whether your prepared to suffer them versus the risk of illness or complications.

The NHS doesn’t like informed patients.

Sorry but that’s not true, there may be individuals who don’t but it makes my job a lot easier when people understand their illness or medication. I wish more people did take notice rather than the ‘Oh I don’t know why I take them the Dr put me on them, well you don’t like to ask do you?’

Interested in a Dr’s opinion on this, easier, harder or generally no different?

I’m not a Dr but find it easier to work with those with medical knowledge for similar reasons above, to be clear a proper medical knowledge or understanding not a wikipedia one.

The very rare occasions I visit my GP we openly discuss treatments or investigation options as they understand I know why they may chose one over the other but also are willing to listen to what I would prefer.

Can you imagine spending £430m on educating and promoting Healthy eating? These drugs wouldn’t need to be used if we all ate proper food.

Profit of course is more important than the health of the nation.

What about doing both encouraging people to eat health and helping those with genetic problems by giving them meds.

These drugs wouldn’t need to be used if we all ate proper food.

Not true.

Some people will die of heart failure at a relatively young age no matter what they do lifestyle wise. All down to your genes….

I work for NICE. Specifically, I work in the Clinical Guidelines arm which produces this type of advice.

For those of you chucking around the idea that this is all a Big Pharma conspiracy: the way guidelines are produced, specifically the type of recommendations that can be made, is designed to be about as unbiased as you can get. Everyone involved, from the data-crunching backroom staff like me to the people who sit on the panel that makes recommendations, has to go through a process that checks they are as neutral as possible and not coming with some hidden agenda (be that being in the pay of pharma, or influenced by them in some other way, or whatever). My job is to sift the evidence that allows the panel to make recommendations. Every relevant scrap of evidence that exists has to be taken into account, again following a process designed to be completely transparent and as unbiased as possible*.

It’s by no means a perfect system, but it’s a lot more thorough and unbiased than good old boys sat round a table, or reading stuff on the internet and believing the bits you like the sound of.

*not the same thing as completely unbiased due to the legion of problems with the way clinical evidence is gathered and reported. I’m well aware of that.

EDIT: not getting sucked into the debate on whether this particular recommendation is right or wrong, just letting you know the process behind it, and many other decisions like it that don’t make the headlines.

Whilst I am not a fan of statins, there is a lot of evdience to show that statins clearly work in lowering CVD, but not through lowering cholesterol.

However, they also do not lower overall mortality.

From the 4S study mentioned above (all cause mortality)

Every relevant scrap of evidence that exists has to be taken into account, again following a process designed to be completely transparent and as unbiased as possible

That process is almost completely undone by your later statement.

*not the same thing as completely unbiased due to the legion of problems with the way clinical evidence is gathered and reported. I’m well aware of that.

legolam – That’s an interesting graph!

legolam – That’s an interesting graph!

It is, it clearly shows that statins are better than placebos. The science is pretty clear, then, as I’m sure you’ll be the first to admit.

winston_dog: as I also say, it’s by no means a perfect system and nobody pretends that it is. Lots is being done to improve the way evidence is collected but you don’t change these things overnight.

As the originator of the Big Pharma jibe I should perhaps clarify. I’m not trying to slur anyone’s reputation and apologise for any offence. I almost take back the initial comment (‘man on internet has his mind changed shocker’) it was just a slightly idealistic musing about the way these things get compartmentalised and we lose sight of the big picture. Not much you can do about your genetics, an awful lot you can do about lifestyle. But that’s just too difficult for most people and the easy solution is to hand the problem across to the GP, the pharmacist, the intensive care unit.

And I bet the NICE people are regulated up to their eyeballs and are a lot less cavalier in their jobs than I am 🙂

Every relevant scrap of evidence that exists has to be taken into account, again following a process designed to be completely transparent and as unbiased as possible

That process is almost completely undone by your later statement

Love it!: Multi-million pound, world leading organsitation has it’s entire rational rubished in one scentence by bloke on the internet!

Or maybe…

Love it!: Multi-million pound, world leading organsitation has it’s entire rational rubished in one scentence by bloke on the internet!

If you read Bad Pharma you’ll find there is a billion dollar industry doing it’s best to manipulate organisations like NICE by being very devious over what trial results they release and what they bury. Conning NICE, or any regulator, into recommending a drug can make billions in profit, so it’s a very serious and large business.

there is a billion dollar industry doing it’s best to manipulate organisations like NICE by being very devious over what trial results they release and what they bury

There are actually some signs of industry moving in the right direction on this. I’m cautiously optimistic that more than just some good PR for ABPI members will come out of it.

My perception is that it’s less of a problem the longer a drug has been around. When a drug is first made available, it’s usually on the basis of trials either exclusively run by, or at least paid for, by the manufacturer, leaving the data open to exactly the sort of manipulation you suggest. When something has been around for years, like statins have, it allows more opportunity for longer-term trials to be set up (or funded) by public bodies who don’t have an incentive to publish only the results that make one drug look better than another.

I should probably go and delve into the data in the guideline in question, but hey, I’m supposed to be analysing a load of data on something else 😉

If you read Bad Pharma you’ll find there is a billion dollar industry doing it’s best to manipulate organisations like NICE

Oh yes. I’m aware of that. But I think NICE are still slightly more competant than “conspiracy theorist man on the internet”

No. But I’m not so blinkered, that I believe it without the possibility that it could be wrong. Do you really accept that all the stats coming out of big pharma companies are true?

They don’t just come from big pharma, they come from universties, hospitals and various other miscellenious research institutes!

If you read Bad Pharma

I have and if you understood what Bad Pharma was saying then you would come to the conclusion that others have, Pharma only gets away with this in the short term. Statins are not new drugs.

Really interesting video here about how far just a little exercise goes, and how how it can get easily overlooked:

[video]http://m.youtube.com/watch?v=aUaInS6HIGo[/video]