Ueda and colleagues address the 2014 National Institute for Health and Care Excellence (NICE) guidelines based on QRISK2 in commendable fashion.1 It would be interesting to ask them for their opinion on an article very recently published in the Pharmaceutical Journal entitled ‘The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance’,2 which would appear to undermine the very foundations on which QRISK and the NICE guidelines totter.
Not only is there an issue of whether the patient in the consulting room meets the inclusion criteria of the studies that went towards the formulation of any guideline, but also the semantics involved in the word ‘guideline’, which is fundamentally different from ‘code’ (must do). [Definition of CODE: a collection or compendium of laws. A complete system of positive law, scientifically arranged, and promulgated by legislative authority].
What is a poor jobbing GP to do in a 10-minute consultation? When the patient sitting opposite is still worrying about what their cholesterol level is, and the GP is grappling with the far more important QRISK2 odds concept, while empirical science puts cholesterol in the dustbin alongside the multitude of historical medical fashions that in their time were cutting-edge ‘must do’s’?
‘Primum non nocere’ would suggest sitting on one’s hands as one of the safest of options while prescribing a statin among the most dangerous!
In conversation with our local community geriatrician it became evident that the scientific evidence and data were not within their grasp to offer a cogent response.
Will the BJGP step up to the mark with its plethora of professorial wisdom and knowledge to enlighten us on this matter, please?
- © British Journal of General Practice 2017