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Statins
Marketing or patient empowerment?
From Mr J. H. A. J. Durodie, MRPharmS
The response by Stephen
Mann and Jeremy Cottrell (PJ, 26 June, p804)
brings up some important issues. They state that “extrapolation
... can be undertaken with considerable confidence”. No true
science can be based on extrapolated results: such results may be valid
but need to be treated with caution as opposed to “considerable
confidence”. This simply re-affirms the paucity of firm evidence.
They further question whether considering number needed to treat (NNT)
is appropriate for over-the-counter sales — I would dare to dispute
that, unless we believe that the punters can get anything so long as
they pay for it. In a case where community pharmacists will need, and
be expected, to make an assessment before a sale together with providing
appropriate advice and counselling about the use of an OTC medicine,
NNT has to be part of the knowledge base drawn upon before that sale.
The reality is that with a NNT of 71 (see PJ, 5 June, p706) this does
not bode well for the individual patient — I just hope my neighbour
is not relying on the same odds lest I help him benefit at my cost. Furthermore,
bearing in mind that for any long-term medication compliance falls to
abysmal levels after about two years, the likelihood of “customers” continuing
with simvastatin 10mg for any meaningful period is debatable, despite
the fact that this is what they would need to do.
I am convinced that over £150 per annum spent on lifestyle, notably
dietary, improvement would give customers a far better overall health
return for their money than committing themselves to long-term medication
and its associated interactions and adverse effects.
I am grateful to Peter Burrill (PJ, 29 May, p670) and David
Phizackerley (PJ, 5 June, p706) for highlighting some of the not insubstantial issues
related to this POM-to-P move and would urge all community pharmacists
to find out about the evidence (from sources over and beyond that provided
by the marketing representatives) so as to be clear what advice they
offer customers seeking to purchase simvastatin 10mg.
This matter does not lead to a “resounding yes” as Johnson & Johnson
would have us believe. It may well, however, become a postcode money-spinner
at the expense of the “worried well”.
The Government is encouraging our public health role: so, please, think
twice before enabling “customers” to “swallow the tablets” — hook,
line and sinker!
J. Durodie
Redhill, Surrey
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