Comments on Dr Rant: Saving money NHS style

There is so much wrong with this story. It shows h...

2008-05-03T08:13:00.000+01:00

There is so much wrong with this story. It shows how bad science and Pharma input has completely buggered up GPs' professionalism.

Firstly, she does not need to be on a statin at all. Statins do not risk in women and in primary prevention.

Secondly, if statins do any good it is due to their anti-inflammatory effect and nothing to do with lowering cholesterol. Therefore the best dose is the lowest and cheapest which gives benefit for the least amount of sideeffects. eg 10mg simvastatin.

Thirdly, ezetimibe has no effect on improving life expectancy, des[ite lowering cholesterol. It is totally discredited and the company is being investigated for the way it conned regulators into giving it a license. It should never be used as it is ineffective, causes side-effects and is very expensive.

GPs and pharmacist and PCOs have been conned by the QoF and Pharma into arguing about money and ridiculous cholesterol levels, when they shold be concentrating on what is best for he patient.

Primum Non Nocere.

Urbain Le Grandier

When did a pharmacist last treat a patient, eh?Mor...

2008-05-02T17:24:00.000+01:00

When did a pharmacist last treat a patient, eh?

More to the point, when did one last take responsibility for the outcome??

I have a similar 'fuck 'em' all attitiude to pharmaNAzis - I went to medical school,it's my name on the script, and on my head be it.

Simvastatin is cheap and will get about 50 - 60% o...

2008-05-02T12:50:00.000+01:00

Simvastatin is cheap and will get about 50 - 60% of patients to the current target - though that is about to be lowered to 4 & 2 by NICE. Upping the dose of Simvastatin above 40 only increases the chance of side effects. I use Rosuvastatin second line, even cheaper than Atorvastatin but more effective. The PharmaNazis have red-listed it here but fuck 'em. When did a pharmacist last treat a patient, eh?

Dr Pink,You are confusing sunsequence with consequ...

2008-05-01T22:34:00.000+01:00

Dr Pink,

You are confusing sunsequence with consequence here (with regard to the Clopidogrel).

I have no idea what doses were involved here but it is perfectly reasonable to do 10mg Atorva to 40mg Simva switch, which, usually, results in a further lowering of the cholesterol, in my experience.

20mg to 40mg is also fine, as long as the patient is well controlled (i.e. cholesterol around 4) bvefore the switch.

The addition of ezetimibe here is the odd part, not the switch policy

This particular patient's compliance is exemplary-...

2008-05-01T21:48:00.000+01:00

This particular patient's compliance is exemplary- almost obsessive compulsive!

Actually, there is limited research on the safety ...

2008-05-01T20:45:00.000+01:00

Actually, there is limited research on the safety of switching to cheaper statins.

The only study I know of - a small one - showed a significant increase in negative outcomes.

Like the time the Gestapo...er, I mean, PCT Pharmacy Advisors told us to stop Clopidegrol after six months.

First patient we stopped ended up on CCU with a letter from the consultant cardiologist to say 'ignore the Gestapo: they talk shit' (I'm paraphrasing slightly, but that was the gist).

The issue here is the addition of ezetimibe - a bi...

2008-05-01T17:48:00.000+01:00

The issue here is the addition of ezetimibe - a bit of a shit drug - rather than conversion to a generic statin, which is generally a good idea and cost-effective in the long-term. Check compliance +/- increase the dose if the cholesterol is too high.