As a working GP of nearly 20 years’ experience with a longstanding interest in prescribing issues, I am concerned about the growing use of statins to the point where our local guidance suggests checking blood lipids on everyone of 40 years of age every five years, regardless of whether or not they have risk factors. Now we have Nice seemingly advocating statins for anyone with a risk of 10 per cent or more.
This would mean that every single man aged 51 and over who had a normal blood pressure reading of 140 systolic, a normal total cholesterol:HDL cholesterol ratio of 5.0, who had never smoked, who had no significant family history, and no significant personal medical history would be put on to a statin.
I am horrified by this “statins in the water” approach to primary prevention and healthcare. It will create large profits for “big pharma” and it will needlessly medicalise millions of people, but the evidence that such an approach to primary prevention will significantly help these individuals is just not there.
The benefits and risks of statin treatment need to be made explicitly clear to allow patients to make a truly informed choice. The absolute risk reductions for stroke and heart attack with primary prevention using statins are small. If patients are treated for five years then: 98 per cent will see no benefit; 0 per cent will be helped by being saved from death; 1.6 per cent (1 in 60) will be helped by preventing a heart attack; 0.4 per cent (1 in 260) will be helped by preventing a stroke. It seems wrong to me to be putting 260 people on a statin so that one person can benefit.
I am 48. I have never had my lipids checked – I have no risk factors so I see no point in ever having them checked.
Dr Stephen McCabe
I am relieved to hear that a note of caution has been sounded on the increased prescribing of statins to people who are healthy.
In my personal experience these pills are certainly not without side-effects. I was prescribed statins on two occasions, and each time I succumbed to a bout of severe depression approximately three months later. I have not had any other episodes of depression.
I am aware that many people take them with no ill effects at all; however, I do not think people should take them unless absolutely necessary.
Gove’s muddle over ‘British values’
Michael Gove may remember Gordon Brown adding “British values” to the citizenship curriculum in 2008, to address issues of diversity and integration. Unfortunately, Mr Gove also emasculated the same theme in his curriculum review, and has turned a blind eye to the delivery of citizenship, the natural home for “inculcating British values in the curriculum”, as Mr Cameron puts it.
Academies and free schools (roughly half our secondary schools) can choose not to teach the subject at all, and routine Ofsted school inspections do not review it. As a consequence, its omission goes overlooked in state schools.
It was noticeable therefore that Ofsted came down heavily in judging that one recently-demoted Birmingham Academy (Park View) had “not taught citizenship well enough”. This snap judgement will surprise teachers who have got used to Gove’s blind eye. The spotlight was thrown on to citizenship because alarm bells rang in Whitehall; the failure to deliver the subject was then picked up when the school was re-inspected under the “Trojan Horse” investigation.
This illustrates the problem: inspection of a school’s delivery will only occur when it is already too late. This should be reviewed immediately. Our schools need clarity that citizenship on the National Curriculum must be delivered effectively and will be inspected routinely (sometimes with no notice) as part of a broad and balanced curriculum. This will go some way to assure citizens that democratic values will be comprehended by the British population.
Andy Thornton, Chief Executive
Andrew Phillips (Lord Phillips of Sudbury), Founder and President
The irony is that Michael Gove is a fan of faith schools, and has suggested they become academies to avoid “unsympathetic meddling” from secularists. He has even approved free schools run by creationists.
Gove should be consistent, and withdraw the right of any publicly funded school to indoctrinate children and discriminate on the basis of religion.
Jihadist demon loosed on the world
The fall of Mosul has brought into sharp focus what you said in your editorial of 9 June.
The imperialist-drawn border between Iraq and Syria now has disappeared. The well armed and equipped Isis jihadis with their exploits in Mesopotamia are going to become the magnet to draw in the foot soldiers of other militias now doing the jihad in Syria.
Perhaps that might momentarily lessen the pressure on Assad’s forces. But the demon that the obscurantist interpretation of Islam, Saudi Wahhabism has foisted, with Western connivance, upon the Muslim world, will hurt all, including the world Bush and Blair inhabit.
May Allah’s mercy be upon them.
M A Qavi
Legacy of the Second World War
I must take issue with Colin Crilly (letter, 9 June). In none of the recent television coverage of the First World War or D-Day have I detected any attempt to celebrate war. Rather the attempt has been to present a more critical and fairer analysis of these events than in the past.
True, Churchill was an avowed imperialist, but there is no evidence that preservation of empire was the overriding motive behind his strategic thinking on occupied Europe. He and Roosevelt reached agreement in 1942 about the need to open a second front in the west.
If Churchill showed any hesitation about this, it was about the timing rather than the necessity. He knew that we were not ready for it and was aware of the risks that lay in haste and poor preparation. His misgivings were vindicated by Dieppe. The claim that we barely engaged the Germans on land between Dunkirk and D-Day is not only untrue but insulting to all our troops who fought and died in the North Africa campaign.
Few would claim that the allied campaigns were completely innocent of atrocities. However, nothing which the allies did could equate to the systematic inhumanities visited for years upon the victims of Nazism.
As to the Second World War’s legacy, there was never any guarantee that it would be one of worldwide peace, but at least it has lead to almost unbroken peace in this continent since I was born seven years after the war ended, a legacy for which I am truly grateful to those who, like my father, gave so much to earn it for us.
Terence A Carr
Bad and good violence
Rosie Millard is right (10 June), Angelina Jolie is beautiful and smart and is ideally placed on the world stage to draw attention to sexual violence. However we must not forget that she gained most of her fame by starring in violent films.
So while she continues to do admirable work drawing attention to the abject misery caused by sexual violence in conflict zones, wouldn’t it be refreshing if she could just honestly add a caveat that while hoping to stop this one unpalatable form of violence she and her husband would like to continue to glamorise other forms of violence so that they can carry on raking money in.
Migrants have always kept together
Edward Thomas (letter, 10 June) asserts that until multiculturalism came along in the past half century, immigrants expected to be absorbed into the culture in which they had chosen to settle, but is this true?
Throughout the world immigrants have always tended to cluster together, which has given rise to all the Chinatowns, Little Italys, Jewish Quarters and suchlike. The Brits do it too and “going native” was always considered rather a peculiar thing to do.
Newcastle upon Tyne
Delights of the chalk downs
Reading Michael McCarthy’s lovely article about visiting chalk downland (10 June) inspired me to spend today at Surrey’s top spot, Box Hill. There I saw most of the butterfly species he mentioned, and many orchids too. While he thinks that the Adonis blue is just coming out, I saw only very old specimens. On the other hand, the marbled white and dark green fritillary are just coming out. Delightful!
Thames Ditton, Surrey