Leading doctors have indicated that statins are being rationed by the NHS in a desperate move to reduce expenditure, despite the fact that the drugs often cost a matter of pennies.
Health watchdogs have condemned the decision to limit access to the heart-related medicine, asserting that the wider prescription of statins had been recommended in order to save lives.
However, despite criticism over what many will see as penny-pinching, it is worth remembering that statins remain something of a controversial medicine.
Many believe that simple lifestyle factors, such as increased exercise, improved diet, ceasing smoking and reducing alcohol intake, are more effective than taking the drugs in question.
The drugs, which reduce the cholesterol level of patients, cost less than 10p per patient per day, underlining the rather bizarre nature of this particular financial decision.
This latest financial move can be placed in the context of an extremely challenging healthcare climate, in which NHS trusts face massive deficits, while being tasked with achieving billions of pounds worth of efficiency savings.
But Stockport CCG has caused fury from senior doctors and from Nice, after ordering local GPs to ignore the Nice advice, instead restricting the drugs to those at greatest risk.
It seems difficult to defend the decision to limit access to statins, considering the relatively trivial amount of money involved.
Dr Andrew Green, chairman of a British Medical Association committee on prescribing, believes that funding is at the heart of the issue, and the statin prescription can be considered a mere symptom of a wider malaise.
“So many CCGs are in deficit due to under-funding, and the pressure on them to achieve financial balance is so great that we are beginning to see some very strange decisions born out of desperation.”
The CCG released a statement outlining the reasons behind the statin rationing.
“The CCG was required to make some decisions on savings to achieve financial balance and long-term financial health. The plan included a decision to not implement the NICE lipid modification guidelines for primary prevention in full.”
But Professor Mark Baker, director of the centre for clinical practice at Nice, was critical of the CCG’s decision, believing it could be a policy that ultimately indirectly kills.
“Cardiovascular disease maims and kills people through coronary heart disease, peripheral arterial disease and stroke. Together, these kill one in three of us. This decision amounts to denying patients access to the most effective means of reducing that risk. Our guidance is intended to prevent many lives being destroyed and it offers a major shift in public health outcomes at relatively low cost.”
Responding to the widespread criticism, a Department of Health spokesperson defended its health service funding, and indicated that statin rationing is not obligatory.
“Doctors should make decisions about prescribing statins based on clinical evidence – there should be no blanket restrictions. We are giving the NHS more money – £4 billion this year – to fund its own plan for the future, and it’s vital that money is spent effectively.”
Health experts have suggested that statins do little good in the fight against high cholesterol, and that simply eating an apple every day would be more beneficial for the public.
In a debate in the BMC Medicine Journal, consultant cardiologist Dr Aseem Malhotra and Professor Simon Capewell of Liverpool University expressed their belief that statins result in severe side-effects, while having little benefit on health for the majority of people that take them.
While studies have suggested that statins can indeed have a positive influence on health, Malhotra and Capewell argue that this is not reflected by real-world usage.
Data on statins indicates that around 50% of patients ceased taking the drug within 12 months of commencing, and 62% of these people stated that the reasoning behind this was muscle pain and fatigue.
“The published literature states an unequivocal mortality benefit for patients with established heart disease. However the same does not apply to primary prevention, especially in individuals of low risk. The focus in primary prevention should the form be on foods and food groups that have a proven benefit in reducing hard endpoints and mortality,” Malhotra argued.
In addition, Malhotra stated in the article that lifestyle factors should be considered central to this issue, and that simply addressing the cause of high cholesterol will have the most beneficial influence.
“For those at low risk, eating an apple a day has an equivalent risk reduction for myocardial infarction as taking a statin. More than 80 per cent of cardiovascular disease is attributable to environmental factors, notably unhealthy diet and also smoking, alcohol and physical inactivity. The focus in primary prevention should the form be on foods and food groups that have a proven benefit in reducing hard endpoints and mortality.”
Britain is rapidly becoming the European capital of statins, considering that it has already generated the second highest rate of prescription of the drug.
This is occurring in the context of spiralling obesity and diabetes rates, and has prompted aggressive prescription of the medication by GPs.
Critics of this trend point to the fact that doctors’ pay is linked to the take-up of the pills.
This has led to statins becoming the most commonly prescribed medication in Britain, costing the NHS in the region of £1/2 billion annually.
It seems rather elementary to conclude that the financial incentives offered to general practitioners is leading to statins being prescribed in many unsuitable circumstances.
Under revised NHS guidance, the majority of men aged over 60, and women over 65, are offered the drugs, even if they only have a one in 10 chance of developing cardiovascular disease within 10 years.
Capwell instead argues that the dangers of the drug significantly outweigh the benefits.
“Pfizers own patient information leaflet of atorvastatin states that the common side effects of the drug include pain in the throat, nauseam indigestion, join and muscle pain and increases in blood sugar levels. Fortunately the majority of these symptoms may be reversible on cessation of the drug. However the small increased (0.5 – 1.1 per cent) risk of type 2 diabetes now directly attributed to statins should not be dismissed lightly.”
7 million people in the United Kingdom are currently prescribed statins, while over half of all adults in England have raised cholesterol.
A group of leading doctors have suggested that the NHS must prepare to utilise medicines that prevent rather than merely treating disease.
The Academy of Medical Sciences believes that so-called personalised medicines which are tailored to the needs of individuals provide an excellent opportunity for the health service.
It is believed by the organisation that public health should head in this direction as a general trend.
Meanwhile, a debate is taking place on the subject, as critics of the opinion of the academy suggest that lifestyle focus should be the central facet in preventing illness.
The Academy states that scientific advances mean in future that there will be more opportunities to intervene with treatment before there are any symptoms.
Commenting on the issue, Professor Sir Robert Lechler, the new president of the Academy of Medical Sciences, stated his belief in the concept of prevention.
“I think it’s unarguable that prevention is better than cure, and if you wait until the patient presents with signs or symptoms of kidney disease, liver disease, heart disease, very often most of the damage is done and can’t actually be recovered. So if it were possible to take steps while still in health to prevent or delay the onset of disease that seems to make very good sense.”
As the debate continues over this issue, discussion related to the use of statins has been particularly prominent.
The controversial medicine has been utilised for people at low risk of heart attack and stroke, yet critics suggest that statins have been used too frequently.
Professor Carl Heneghan from the Oxford University Centre for Evidence-Based Medicine, believes that a focus on lifestyle factors will ultimately have a significantly more beneficial influence.
“What we have to do is look at clear lifestyle risk factors. The future of healthcare is a healthier lifestyle. Only in certain diseases such as cancer will we find personalised treatments are effective.”
Many analysts believe that over-medication is a major problem in the NHS, and it has been particularly noted that prescription drugs are the third most common cause of death after heart disease and cancer.
It is noted that it will only be possible to reduce demand on the NHS, and thus consequently improve care in the health service, by addressing a series of toxic lifestyle issues.
Nonetheless, the academy continues to call for closer collaboration between the NHS, academia and the pharmaceutical industry in the research and development of new drug solutions.