Saturday, 19 May 2012

Statins – mass prescribing for the healthy may create a different kind of problem.

Healthcare is, like most things in life, all about balance. As each new ‘magic bullet’ - a new medication, procedure or technological miracle is discovered, the balance of one disease or condition may be slightly tipped in its favour, but this is often to the detriment of some other ailment.

I’m not talking about allocation of funds, I’m talking about how solving one problem can either create or expose another. It’s a bit like building a ring road round a major city. In theory, business and leisure travel either side of the conurbation will become easier. But what usually happens? You simply move the traffic jams to another point in the transport system. Just ask anyone who has travelled on the M25, hailed as the end to London’s potential gridlock but now known as the biggest car park in the UK as the motorway struggles to cope with the high volume of traffic it has created simply by existing.

The biggest killer for some age groups in the UK is heart disease closely followed by cancer. Add chronic conditions such as dementia, diabetes and all obesity related conditions and a turgid melting pot of health nightmares bubbles away fuelled by bad lifestyle choices and social inequalities. It is expected that there will be 1 million dementia sufferers within the next decade and there are currently 3.8 million people suffering from diabetes – expected to double in the next 20 years.

Sadly or happily – whichever way you look at it – state funded health care is a victim of its own success. The reason dementia has become such a problem is because we are actually pretty good at keeping people alive for longer. And now there is talk of prescribing statins to everyone in the UK over 50, whether they are obese, sedentary, super fit or just plain average. Following a study by Oxford University, it is estimated that mass prescribing of these ‘cholesterol busting’ drugs will avoid 11 heart attacks per 1000 individuals. Tempting as this may seem, giving drugs with a worrying range of potentially unpleasant or dangerous side effects to healthy individuals feels like a bridge too far, especially if this lets us off the hook for increasing exercise and adopting a healthy diet. In the ‘good old days’ – if your cholesterol was a bit high – you were advised to eat better and move more. Often this was sufficient to reduce the cardiovascular risk.

Yes, of course statins are life savers especially for those with familial hypercholesterolemia, genetically inherited and potential life threatening high level of ‘bad’ cholesterol. But should we be tempted to, as Janice Turner in The Times newspaper so beautifully put it – ‘pop a pill if you’re not ill’.? If the subliminal message is that it’s OK to get fat and don’t  exercise,  but take statins to counteract the damage that high cholesterol will cause, then there may be a new generation of obese patients, living longer but prey to other obesity-related conditions.

As cardiovascular disease falls, cancer incidence may rise.


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