Last year I attended a dinner with several senior NHS officials, politicians and business leaders to discuss the problems facing the health service.
I was the youngest there by far, as the rest of the party were men in their 50s or 60s. Dessert was served, a delicious meringue with citrus fruit and heaps of whipped cream. Everyone tucked in.
Before plates were cleared, I glanced round at the table and noticed that all the guests had left the grapefruit segments. I turned to the person next to me and commented how odd it was that not one person liked grapefruit. ‘Oh, I love grapefruit,’ he replied. ‘But I’m on statins and I can’t eat it.’
I know that grapefruit interacts with certain statins (and other drugs) and can increase the risk of side effects. But surely not all those seated at the table were on them? So I asked my fellow guests. Yes. Everyone sitting at that table had left their grapefruit for the same reason.
Statins are increasingly prescribed not because people are sick but because there is a theoretical risk that one day they might be.
That was the moment I realised how pervasive these drugs have become, increasingly prescribed not because people are sick but because there is a theoretical risk that one day they might be.
It occurred to me how ironic it was that these men, who were popping statins to protect themselves against heart disease, had turned their noses up at the grapefruit but hoovered up the meringue, and were attacking the cheese plate as they poured cream in their coffee.
I recalled that dinner yesterday when considering the new research suggesting that, under guidelines issued by the National Institute for Health and Care Excellence (NICE) nearly 12 million adults in England aged 30 to 84 — including nearly all men over 60 and all women over 75 — should be taking statins.
This would put an entire generation on pills, most of whom are otherwise healthy, to benefit a small minority of those at risk. To me, that warrants serious reflection.
Some 67 million NHS prescriptions were written for statins last year. And there is no doubt that they can be a life saver for some, and prevent disability in others. They are effective at reducing levels of ‘bad’ cholesterol, which can build up in blood vessels, leading to strokes and heart attacks, as well as damaging other organs such as the kidneys and eyes.
I was at a dinner party where nobody left their healthy grapefruits because they interact with certain statins
Statins, which are derived from a fungus, were approved for use in 1987 and have become an established part of managing high cholesterol. But what constitutes ‘high’ is relatively arbitrary. What we have seen in recent years is ‘medication creep’ such that more and more people are being included in the guidelines.
NICE issued its first guidance on the use of statins in January 2006. It recommended the drugs for people who showed evidence of cardiovascular disease; those whose 10-year risk of developing it was 20 per cent or higher; or who came from high-risk groups, for example diabetics.
In 2014, NICE revised its guidance, lowering the threshold of risk from 20 per cent to 10 per cent. Overnight, 4.2 million more people were recommended the drugs. Adults who, a few years ago, would have been judged to have cholesterol levels that could be managed by diet and exercise, were being put on statins.
There was no new evidence to support this change. In fact, there continues to be a woeful lack of clarity on whether NICE guidelines are based on sufficient evidence. There is an unacceptable lack of transparency in statin research.
More worrying is the fact that much of this research is supported or funded by companies which have an interest in demonstrating the benefits of these drugs and downplaying the disadvantages.
When NICE revised its guidelines in 2014, it